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1.
Zhonghua Yi Xue Za Zhi ; 100(6): 442-446, 2020 Feb 18.
Artigo em Chinês | MEDLINE | ID: mdl-32146767

RESUMO

Objective: To analyze the clinical features and prognosis of lung cancer patients with metastasis-induced acute pancreatitis (MIAP), and to provide clues for early diagnosis. Methods: The characteristics and prognosis of 8 patients with MIAP in lung cancer admitted to Peking Union Medical College Hospital from January 2002 to September 2019 were retrospectively analyzed and were compared with non-tumor-induced AP. Results: Sevencases(7/8) were Mild AP, one (1/8) was Severe AP. Four patients (4/8) presented with AP as the reporting sign and lung cancer was not diagnosed until (112±36) days after the onset of AP. Clinical manifestations included abdominal pain (8/8), weight loss (4/8), nausea and vomiting (2/8), and jaundice (1/8). Stages of lung cancer were all Ⅳ.Histopathology proved that seven cases (7/8) were small cell lung cancer, and one case (1/8) was poorly differentiated adenocarcinoma. The median survival time was 11 months. Compared with non-tumor-induced AP, lung cancer patients with MIAP were older[(62±9) vs (48±15), P=0.018], the incidence of primary pancreatic duct dilatation (37.5% vs 3.1%, P=0.004) and abdominal lymphadenopathy (37.5% vs 6.3%, P=0.017) were higher; the level of hemoglobin [105.3±15.6) g/L vs (147.9±24.8) g/L, P<0.001] and hematocrit [(31.4±5.3) vs (42.5±6.1), P<0.001] were lower. Conclusions: Patientswith MIAP in lung cancer had poor outcome and unspecific symptoms. Old age, anemia, main pancreatic duct dilatation and abdominal lymphadenopathy are diagnostic clues that merit clinical attention.


Assuntos
Neoplasias Pulmonares , Doença Aguda , Humanos , Pancreatite , Estudos Retrospectivos
2.
Zhonghua Nei Ke Za Zhi ; 59(3): 253-256, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32146759

RESUMO

Diarrhea is a common digestive symptom. Here, we reported a case of young patient admitted with diarrhea caused by lead poisoning and cytomegalovirus infection. Through informative medical history and multi-disciplinary team discussion, Satoyoshi syndrome was finally diagnosed.


Assuntos
Alopecia/diagnóstico , Osso e Ossos/anormalidades , Diarreia/diagnóstico , Espasmo/diagnóstico , Infecções por Citomegalovirus , Humanos , Intoxicação por Chumbo
3.
Zhonghua Yi Xue Za Zhi ; 100(10): 757-762, 2020 Mar 17.
Artigo em Chinês | MEDLINE | ID: mdl-32192288

RESUMO

Objective: To investigate the correlations of serum total 25-hydroxyvitamin D (T-25 (OH) D) levels with serum cytokine levels including interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor α (TNF-α) and Crohn's disease activity index (CDAI) in patients with Crohn's disease (CD). Methods: A total of 60 patients with CD admitted in Peking Union Medical College Hospital from April 2014 to March 2019 who completed the tests for serum T-25 (OH) D and cytokines (IL-6, IL-8 and/or TNF-α) were retrospectively enrolled. Clinical data were collected for analysis. Results: Among 60 CD patients, there were 46 male patients, and the age was (34±13) years. There were 16 patients (26.7%) in remission and 44 cases (73.3%) in active status. The T-25(OH)D level was (16.0±7.7)µg/L. The prevalence of vitamin D sufficiency, insufficiency and deficiency was 26.7%, 40.0% and 33.3%, respectively. Correlation analysis showed that serum T-25 (OH) D level was negatively correlated with CDAI (r=-0.363,P=0.004), IL-6 level (r=-0.360,P=0.007), hsCRP level(r=-0.272, P=0.043) and ESR level(r=-0.293, P=0.024), while positively correlated with serum Alb level(r=0.372, P=0.003)、Hb(r=0.330, P=0.010) and BMI(r=0.276, P=0.033).Twenty-three cases (52.3%) of active CD patients accompanied with infection had a lower level of serum T-25 (OH) D than those without infection [(12.55±7.17) vs (17.41±6.49)µg/L, P=0.023]. Conclusion: Serum T-25 (OH) D level was negatively correlated with CDAI, serum IL-6 level and inflammatory markers in patients with CD, and it was lower in active CD patients with infection than those without infection.


Assuntos
Doença de Crohn , Adulto , Citocinas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vitamina D , Vitaminas , Adulto Jovem
4.
Zhonghua Yi Xue Za Zhi ; 100(8): 599-603, 2020 Mar 03.
Artigo em Chinês | MEDLINE | ID: mdl-32164114

RESUMO

Objective: To analyze the clinical features of ulcerative colitis associated colorectal cancer (UC-CRC). Methods: A total of 869 inpatients with Ulcerative Colitis (UC) in Peking Union Medical Hospital from January 1998 to January 2018 were continuously enrolled. Clinical data and the outcome of colorectal cancer (CRC) were collected via medical records and telephone follow-up. Chi-square test and logistic regression model were used to analyze the data. Results: There were 16 patients in 869 UC inpatients who were diagnosed with CRC during a period of 7 548 person years and the incidence rate of UC-CRC was 1.84%. Compared to UC inpatients without CRC, a longer course of disease (OR=1.087, 95% CI:1.046-1.129) , a lower usage rate of 5-Aminosalicylic Acid(5-ASA) (OR=0.218, 95% CI:0.052-0.915) and a higher incidence rate of intestinal stenosis (OR=16.533, 95% CI:3.824-71.478) were found in UC inpatients with CRC. Conclusions: A long disease course is a risk factor for UC patients developing CRC, while 5-ASA therapy can reduce the risk of suffering from CRC. For UC patients with intestinal stenosis, CRC should be warned for occurring.


Assuntos
Colite Ulcerativa , Neoplasias Colorretais , Colite Ulcerativa/complicações , Neoplasias Colorretais/etiologia , Humanos , Modelos Logísticos , Fatores de Risco
5.
Zhonghua Nei Ke Za Zhi ; 58(8): 584-591, 2019 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-31365980

RESUMO

Objective: To investigate the effects of probiotics and synbiotics on inflammation and microbiota of acute colitis in mice. Methods: C57BL/6J mice were divided into 4 groups randomly. Each group had 10 mice and was given 2.5% dextran sulfate sodium (DSS) drinking water for 5 days other than the blank control group. Except for model control group, other two groups were administrated with probiotics and synbiotics, respectively. Probiotics was composed of Lactobacillus acidophilus, Lactobacillus rhamnosus and Bifidobacterium lactis, while synbiotics was composed of the aforementioned probiotics, inulin and galactooligosaccharide. Feces of different periods and mucosa samples were collected to analyze the differences of enteric flora by 16s rDNA sequencing. Results: (1) Pathological scores in probiotics group and synbiotics group were 5.40±2.79 and 7.25±2.87, respectively, which were significantly lower than those in the model control group with scores 27.00±7.94. Model control group, probiotics group and synbiotics group showed lower flora diversity, increased Bacteroides and decreased Faecalibacterium than blank control group. The mucosal microbiota was different from fecal flora in abundance and species for each group, and Mucispirillum was more common in mucosa. Conclusions: Probiotics and synbiotics alleviate the inflammation of acute colitis in mice. Imbalance of beneficial genera to harmful genera is the characteristic of acute colitis. Supplementation of probiotics and synbiotics contributes to regulating the balance of intestinal microbiota.


Assuntos
Colite/tratamento farmacológico , Colo/microbiologia , Fármacos Gastrointestinais/administração & dosagem , Microbiota/efeitos dos fármacos , Probióticos/administração & dosagem , Simbióticos/administração & dosagem , Animais , Colite/induzido quimicamente , Colo/efeitos dos fármacos , Modelos Animais de Doenças , Fezes/microbiologia , Fármacos Gastrointestinais/uso terapêutico , Inflamação , Camundongos , Camundongos Endogâmicos C57BL , Probióticos/uso terapêutico
6.
Zhonghua Yi Xue Za Zhi ; 99(22): 1735-1742, 2019 Jun 11.
Artigo em Chinês | MEDLINE | ID: mdl-31216822

RESUMO

Objective: To investigate the effects of probiotics(VSL#3, S. Boulardii) on intestinal flora of mice with DDS-induced acute colitis. Methods: C57BL/6J mice were administered with 2.5% dextran sulfate sodium for 5 consecutive days to develop the acute colitis model except for the blank control group. Meantime,Mice were treated with drinking water (DSS model group),VSL#3 (1.5×10(9) CFU),or S.Boulardii(5×10(7) CFU) by gavage for 7 days respectively,and mice were sacrificed 2 days after the model of colitis was established. The fecal specimens before gavage (day 0),in the middle of experiment (day 4),and the end of gavage (day 7) and the intestinal mucosa after sacrifice were collected to analyze the differences between these four groups by 16s rDNA sequencing method. Results: Compared with the DSS model group, VSL#3 group showed a decrease in disease activity index (DAI) and histological scores, and there was no significant change in the S.Boulardii group. Fecal microbiota:in the middle of experiment,the alpha diversity of DSS model group,VSL#3 group and S.Boulardii group were lower than that of the blank control group(P=0.0135,P=0.0018,P=0.0151). After the end of gavage,the diversity of the VSL#3 group was lower than that of the blank control group(P=0.025), and the difference between any other two groups was not statistically significant. Mucosa-adherent microbiota:biodiversity of DSS model group,S.Boulardii group were lower than the blank control group(P=0.031,P=0.0437),while biodiversity of VSL#3 group was higher than DSS model group and S. Boulardii group(P=0.0394, P=0.0426). Compared with the blank control group, the DSS model group showed an increase in Bacteroides and a decrease in Lactobacillus. Abundance in the genus Turicibacter and Odoribacter increased in intestinal microbiota of mice with acute colitis, while VSL#3 inhibited them. Conclusions: VSL#3 alleviates inflammation in DSS-induced colitis of mice.Both VSL#3 and S.Boulardii can affect intestinal microbiota. Compared with healthy mice,mice with colitis showed a reduced diversity of microbiota both in feces and in intestinal mucosa. VSL#3 increases biodiversity of mucosal microbiota in mice with acute colitis,while it does not increase biodiversity of fecal microbiota. Genera such as Turicibacter and Odoribacter increase in mice with acute colitis, and these genera can be inhibited by VSL#3.


Assuntos
Colite , Microbioma Gastrointestinal , Doença Aguda , Animais , Colo , Modelos Animais de Doenças , Camundongos , Camundongos Endogâmicos C57BL
7.
Clin Transl Oncol ; 21(12): 1680-1686, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30955196

RESUMO

PURPOSE: Inflammatory bowel disease (IBD) is an important risk factor for colon cancer. Novel serum immunoinflammation-related protein complexes (IIRPCs) have shown associations with early cancer detection. Herein, we investigated the potential of serum IIRPCs for discriminating between IBD and colorectal cancer (CRC) patients. METHODS: Serum protein complexes of 65 healthy controls, 57 CRC, 69 (ulcerative colitis) UC, and 67 (Crohn's disease) CD patients were isolated by native-PAGE. The gray values of serum IIRPCs bands in the gel were quantified using Quantity One software. The receiver-operating characteristic (ROC) curves were constructed to assess the discriminating ability by calculating the area under the ROC curve. RESULTS: The serum IIRPCs levels in IBD and CRC patients were significantly elevated compared to healthy controls. ROC analysis indicated certain diagnostic ability of serum IIRPCs in differentiating IBD from CRC. Specifically, "a3" complex discriminated UC from CRC, with an AUC value of 0.722, sensitivity of 69.4% and specificity of 63.8%. Similarly, "b4" complex discriminated UC from CRC, with an AUC value of 0.709, sensitivity of 70.4%, and specificity of 60.0%. In addition, the "a3" complex also discriminated CD from CRC, with an AUC value of 0.785, sensitivity of 73.1%, and specificity of 74.1%, while the "b4" complex showed a tendency to discriminate CD from CRC, with an AUC value of 0.663, sensitivity of 67.9% and specificity of 50.0%. Thus, an equation based on multiple IIRPCs was built to further improve the discriminating power. CONCLUSIONS: Serum IIRPCs can be used to discriminate IBD from CRC and may also be associated with early screening of colitis-associated cancer.

8.
Zhonghua Nei Ke Za Zhi ; 58(2): 139-142, 2019 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-30704201

RESUMO

Objective: To investigate the correlations between gastric Helicobacter pylori (Hp) infection and colorectal polyps or cancer. Methods: Among patients who finished colonoscopy exams in Peking Union Medical College Hospital (PUMCH) between May 2012 and May 2017, 3 483 patients were diagnosed with colorectal polyps, 135 patients with newly diagnosed colorectal cancer. A total of 1 925 healthy subjects were enrolled as normal controls. Gastric rapid urease tests (RUT) were done in all patients. General clinical data, RUT results, sizes and numbers of polyps, cancer location were analyzed. Results: The proportion of Hp infection in patients with colorectal polyps was 31.5%, higher than that in healthy controls. The odds ratio (OR) of Hp infection in polyp group was 1.17 (95%CI 1.04-1.32) after age and gender were adjusted. The Hp infection rate in patients with polyps over or equal to 1 cm was significantly higher than that in patients with polyps smaller than 1 cm. Patients with more than 1 polyps presented a higher rate of Hp infection than patients with only 1 polyp. Hp infection rate in patients with colorectal cancer was 36.3%, with the adjusted OR 1.56 (95%CI 1.06-2.30). The location of colorectal cancer was not correlated with Hp infection. Conclusions: Gastric Hp infection is more common in patients with colorectal polyps than in healthy controls. Polyps ≥1 cm, multiple polyps and colorectal cancer are correlated with higher rates of Hp infection. Cancer location is irrelevant to Hp infection.


Assuntos
Pólipos do Colo/diagnóstico , Neoplasias Colorretais/diagnóstico , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Gastropatias/epidemiologia , Colonoscopia , Humanos
9.
Zhonghua Nei Ke Za Zhi ; 58(3): 224-228, 2019 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-30803185
10.
Zhonghua Nei Ke Za Zhi ; 58(3): 237-240, 2019 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-30803188

RESUMO

Fever and abdominal pain are common symptoms and could be main manifestations in patients with autoinflammatory diseases. A 48-year-old female patient was admitted with recurrent fever and abdominal pain for 9 years. Serum level of inflammatory markers synchronously fluctuated with fever, and returned to normal when fever subsided. The periodic episodes of fever occurred every 1 to 4 months and failed to respond to empirical antibiotics. Whole exome sequencing showed heterozygous mutation of NOD2 gene q902k, leading to the final diagnosis of autoinflammatory disease. Corticosteroid and tripterygiumglycosides were effective for the disease remission.


Assuntos
Dor Abdominal/etiologia , Febre/etiologia , Doenças Hereditárias Autoinflamatórias/diagnóstico , Proteína Adaptadora de Sinalização NOD2/genética , Úlcera/etiologia , Corticosteroides/uso terapêutico , Feminino , Glicosídeos/uso terapêutico , Doenças Hereditárias Autoinflamatórias/tratamento farmacológico , Doenças Hereditárias Autoinflamatórias/genética , Heterozigoto , Humanos , Pessoa de Meia-Idade , Mutação , Resultado do Tratamento
11.
Zhonghua Nei Ke Za Zhi ; 57(7): 487-493, 2018 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-29996266

RESUMO

Objective: To investigate the clinical and pathological characteristics of chronic active Epstein-Barr virus associated enteritis (CAEAE) . Methods: The clinical data of 6 CAEAE patients in Peking Union Medical College Hospital were retrospectively analyzed from January 2010 to November 2017, including clinical manifestations, endoscopic, pathological features, medications and clinical outcome. Results: The male∶female ratio was 4∶2 and the average age was 34 years old. All patients did not have personal and family history of immunodeficiency. The common symptoms consisted of fever (6/6), abdominal pain (6/6), hematochezia (6/6) and diarrhea (5/6). The most frequently affected sites were colorectum (5/6), followed by small intestine (3/6). Further serologic tests revealed a high load of serum Epstein-Barr virus(EBV) DNA. The main manifestations under endoscopy were multifocal or diffuse irregular ulcers. There was inflammation in the ulcer bases and surrounding areas, where EBV-encoded small RNA (EBER) was positive by in situ hybridization (6/6). The common complications were massive hemorrhage (3/6) and intestinal perforation (2/6). None of treatment agents including glucocorticoid, ganciclovir, foscarnet sodium and cytotoxic drugs was effective. All patients died within 0.5 to 13 months after diagnosis. Conclusions: CAEAE in immunocompetent individuals is a rare disorder with poor prognosis. It is difficult to differentiate CAEAE from inflammatory bowel disease due to similar clinical and endoscopic manifestations.


Assuntos
Enterite/virologia , Infecções por Vírus Epstein-Barr/patologia , Herpesvirus Humano 4 , Úlcera/virologia , Adulto , Enterite/imunologia , Enterite/patologia , Infecções por Vírus Epstein-Barr/imunologia , Feminino , Febre/etiologia , Humanos , Imunocompetência , Hibridização In Situ , Doenças Inflamatórias Intestinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Úlcera/imunologia , Úlcera/patologia
12.
Zhonghua Nei Ke Za Zhi ; 57(8): 614-616, 2018 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-30060340

RESUMO

This is a complicated and difficult case. The onset symptom of a 62-year-old male was recurrent intestinal obstruction. Ileocecal and ileocolic operation was done twice. Massive gastrointestinal bleeding occurred due to giant fistula of descending duodenum, which connected to ileocolic anastomosis. After consultation by multidisciplinary team, jejunal-feeding tube was placed to provide enteral nutrition. With general condition improving, duodenal fistula repair and involved bowel resection were performed. Postoperative pathology confirmed Crohn's disease. The patient was treated with thalidomide and recovered well during follow-up.


Assuntos
Doença de Crohn/patologia , Doença de Crohn/terapia , Fístula Cutânea/complicações , Duodenopatias/complicações , Hemorragia Gastrointestinal/etiologia , Íleo/cirurgia , Fístula Intestinal/complicações , Obstrução Intestinal/cirurgia , Anastomose Cirúrgica , Colo/cirurgia , Doença de Crohn/complicações , Fístula Cutânea/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Duodenopatias/cirurgia , Duodeno , Nutrição Enteral , Humanos , Fístula Intestinal/cirurgia , Obstrução Intestinal/diagnóstico , Masculino , Pessoa de Meia-Idade , Recidiva , Talidomida/uso terapêutico , Resultado do Tratamento
13.
Zhonghua Nei Ke Za Zhi ; 57(4): 275-278, 2018 Apr 01.
Artigo em Chinês | MEDLINE | ID: mdl-29614586

RESUMO

Objective: To reinforce the awareness of colorectal endometriosis (EM) in colonoscopy examination. Methods: Patients diagnosed as colorectal EM at Peking Union Medical College Hospital between February 2002 and February 2017 were enrolled in this study. The clinical characteristics and endoscopic features of EM lesions were summarized and compared between pathologically positive group and negative group. Results: A total of 34 cases were included with average age of (38.3±8.9) years old. All EM lesions located within rectum and sigmoid colon. The endoscopic lesions manifested as protrusion in 21 cases (61.8%) and protrusion-depression in 13 cases (38.2%), local stenosis in 8 cases (23.5%); erosive surface in 33 cases (97.1%) with local spontaneous hemorrhage in 4 cases (11.8%); nodal surface in 23 cases (67.6%), and lymphangiectasis base in 9 cases (26.4%). Endoscopic biopsy specimens were obtained in all cases with average 3 (2, 4) pieces. Positive results were found only in 4 patients (11.8%) with 3 endometriosis and one (endometrial) adenosarcoma. Compared with negative group, spontaneous hemorrhage was more frequent in positive group (2/4 vs. 2/30, P=0.013). Mean biopsy sample number was significantly larger in positive group (5 vs. 3, P=0.004). Conclusions: Colorectal endometriosis is mostly located within rectosigmoid region. Endoscopic features mainly include protrusion or protrusion-depression lesions with erosive and nodular surface, or local stenosis. Spontaneous hemorrhage under colonoscopy yields higher positive rate for biopsy, thus increasing biopsy sample numbers may improve pathology results.


Assuntos
Biópsia , Colonoscopia , Neoplasias Colorretais/diagnóstico , Endometriose/diagnóstico , Feminino , Humanos , Reto/diagnóstico por imagem , Estudos Retrospectivos
14.
Zhonghua Nei Ke Za Zhi ; 57(4): 309-312, 2018 Apr 01.
Artigo em Chinês | MEDLINE | ID: mdl-29614595

RESUMO

A 60-year-old man presented with severe watery diarrhea for 2 months complicated with weight loss and acute kidney injury. He did not respond well to antidiarrheal medicines, empirical antibiotics and dietary exclusion of gluten or even complete bowel rest. The final diagnosis of autoimmune enteropathy (AIE) was made based on histopathologic findings of endoscopic biopsy from duodenal mucosa after excluding neoplastic disease, inflammatory bowel disease, and infectious diarrhea, etc. Chronic diarrhea and oliguria alleviated after the administration of corticosteroids.


Assuntos
Lesão Renal Aguda/complicações , Biópsia , Diarreia/etiologia , Mucosa Intestinal/patologia , Poliendocrinopatias Autoimunes/patologia , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Poliendocrinopatias Autoimunes/diagnóstico
15.
Zhonghua Nei Ke Za Zhi ; 57(2): 112-117, 2018 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-29397596

RESUMO

Objective: To clarify the clinical features of monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) with minor endoscopic abnormalities. Methods: The clinical data of 6 patients with MEITL characterized by minor endoscopic abnormalities in Peking Union Medical College Hospital from 2012 to 2016 were retrospectively analyzed, including clinical manifestations, endoscopic, pathological features, medications and prognosis. Results: Five out of 6 patients were male, with an average age of 61.2 years old. The median disease duration was 4.5 months. All patients initially presented with diarrhea without specific findings for serologic testing. CT enterography showed continuous intestinal lesions, including symmetric thickening of the bowel wall, abnormal hyperenhancement of mucosal surface and lymphadenopathy. Endoscopic appearances were only mildly abnormal, including mucosal swelling, atrophy of villus, mosaic sign and shallow ulcers. Histopathologic findings revealed massive small to medium sized T lymphocytes infiltration with positive expression of CD(3) and CD(8). Chemotherapy and palliative treatment were administrated after diagnosis. Conclusions: Clinical presentations of MEITL are non-specific with minor endoscopic abnormalities. Therefore, biopsy is indispensable for patients with a relatively normal endoscopic result.


Assuntos
Diarreia/etiologia , Endoscopia , Intestinos/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Linfoma de Células T/diagnóstico , Idoso , Antineoplásicos/uso terapêutico , Biópsia , Feminino , Humanos , Linfoma de Células T/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Linfócitos T , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Zhonghua Nei Ke Za Zhi ; 56(12): 909-913, 2017 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-29202530

RESUMO

Objective: To compare the performance of the revision of Atlanta classification (RAC) and determinant-based classification (DBC) in acute pancreatitis. Methods: Consecutive patients with acute pancreatitis admitted to a single center from January 2001 to January 2015 were retrospectively analyzed. Patients were classified into mild, moderately severe and severe categories based on RAC and were simultaneously classified into mild, moderate, severe and critical grades according to DBC. Disease severity and clinical outcomes were compared between subgroups. The receiver operating curve (ROC) was used to compare the utility of RAC and DBC by calculating the area under curve (AUC). Results: Among 1 120 patients enrolled, organ failure occurred in 343 patients (30.6%) and infected necrosis in 74 patients(6.6%). A total of 63 patients (5.6%) died. Statistically significant difference of disease severity and outcomes was observed between all the subgroups in RAC and DBC (P<0.001). The category of critical acute pancreatitis (with both persistent organ failure and infected necrosis) had the most severe clinical course and the highest mortality (19/31, 61.3%). DBC had a larger AUC (0.73, 95%CI 0.69-0.78) than RAC (0.68, 95%CI 0.65-0.73) in classifying ICU admissions (P=0.031), but both were similar in predicting mortality(P=0.372) and prolonged ICU stay (P=0.266). Conclusions: DBC and RAC perform comparably well in categorizing patients with acute pancreatitis regarding disease severity and clinical outcome. DBC is slightly better than RAC in predicting prolonged hospital stay. Persistent organ failure and infected necrosis are risk factors for poor prognosis and presence of both is associated with the most dismal outcome.


Assuntos
Índice de Gravidade de Doença , Doença Aguda , Área Sob a Curva , Feminino , Hospitalização , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Necrose , Pancreatite/classificação , Pancreatite/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
17.
Zhonghua Yi Xue Za Zhi ; 97(36): 2848-2851, 2017 Sep 26.
Artigo em Chinês | MEDLINE | ID: mdl-29050150

RESUMO

Objective: To evaluate the diagnostic value of capsular endoscopy in patients with obscure gastrointestinal bleeding (OGIB) in different age groups, and assess its effectiveness and safety. Methods: A total of 216 patients who were diagnosed with OGIB between March 2005 and March 2016 at Department of Gastroenterology of Peking Union Medical College Hospital were retrospectively reviewed. They were assigned into three groups: young adults, middle-aged and elderly. The demographic characteristics, clinical manifestations, working performance as well as endoscopic features in each group were collected and analyzed. Results: The detection rate and diagnosis rate of the young adults and middle-aged group were 98.53% vs 98.51% (P=0.992), 92.65% vs 91.04% (P=0.734), while those between the young adults and the elderly group were 98.53% vs 91.14% (P=0.109), 92.65% vs 87.34% (P=0.289), and 98.51% vs 91.14% (P=0.113) and 91.04% vs 87.34 (P=0.475) between the middle-aged and elderly group. No significant difference existed in either detection rates nor diagnostic rates between the different age groups. The distribution of the small intestinal lesions varied between the different age groups. The top three common lesions in young adults were vascular malformation, small intestine ulcer and Crohn's disease, while in the middle-aged group vascular malformation, non-specific enteritis and small intestine ulcer were the most common. Patients in elderly group were most likely to have vascular malformation, small intestine ulcer and erosion. Conclusions: For patients of any age with OGIB, capsule endoscopy is a safe, effective and comfortable examination which can be widely used in clinical practice.


Assuntos
Endoscopia por Cápsula , Doença de Crohn , Endoscopia Gastrointestinal , Hemorragia Gastrointestinal , Humanos , Intestino Delgado , Estudos Retrospectivos
18.
Zhonghua Nei Ke Za Zhi ; 56(4): 279-283, 2017 Apr 01.
Artigo em Chinês | MEDLINE | ID: mdl-28355721

RESUMO

Objective: To clarify the efficacy and safety of cyclosporine A (CsA) as salvage therapy in patients with severe active ulcerative colitis (UC) and refractory to steroids. Methods: A total of 24 severe active UC patients refractory to steroids and hospitalized from 2006 to 2012, were retrospectively enrolled.Data including demographic features, clinical manifestations, laboratory tests and medications were collected. Results: CsA was effective in 15(62.5%) patients, who did not receive colectomy during 12-week administration. This regimen was tolerable in most patients.Twelve (50.0%) patients reported 16 adverse events, but only one patient withdrew CsA due to intolerance.The rates of adverse events in initial intravenous CsA including 4 mg·kg(-1)·d(-1,) 3 mg·kg(-1)·d(-1) and 2 mg·kg(-1)·d(-1) were 2/2, 9/17 and 1/5 respectively.Responders had higher white blood cell count compared with non-responders (P= 0.045). Conclusions: CsA could be an effective alternative regimen to colectomy in severe active UC patients who are refractory to steroids.


Assuntos
Colite Ulcerativa/tratamento farmacológico , Ciclosporina/administração & dosagem , Imunossupressores/administração & dosagem , Terapia de Salvação , Administração Intravenosa , Adulto , Colectomia , Ciclosporina/efeitos adversos , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Segurança , Índice de Gravidade de Doença , Esteroides , Resultado do Tratamento
19.
Zhonghua Nei Ke Za Zhi ; 56(2): 112-115, 2017 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-28162180

RESUMO

Objective: Mesenteric panniculitis is an idiopathic, uncommon disease involving the adipose tissue of mesentery. The etiology, diagnosis and treatment are still unnoticed. We thus reported a case series to improve the understanding of this rare disorder. Methods: We retrospectively analyzed the clinical data of 12 patients with mesenteric panniculitis including manifestation, diagnosis, treatment and prognosis. Results: We found a male predominance (M∶F 3∶1) with the median age of 58 years old at diagnosis. The most common symptom was abdominal pain (9/12), followed by abdominal distension (3/12) and weight loss (3/12). Physical examination was unremarkable in the majority of patients (8/12). C reactive protein (9/12) and erythrocyte sedimentation rate (10/12) were normal in majority of patients. CT findings were of much diagnostic value. All patients had small intestinal mesentery involvement and multi-nodular appearance with increased fat density. Pseudo-capsule sign (8/12) and fat halo sign (6/12) were common. Pathological diagnosis was obtained in 4 cases showing fat tissue inflammation with local necrosis and fibrosis. Six cases all received prednisone, 2 with combined cyclophosphamide, 1 with azathioprine, 1 with tripterygium wilfordii. Short-term clinical response was achieved in all cases, but two patients relapsed. Conclusions: Mesenteric panniculitis occurs predominantly in middle-aged and elderly. Abdominal pain is the leading symptom. Inflammatory markers are often normal while computed tomography is the most important diagnostic tool. Surgery combined with cortical steroid and immunosuppressant agents is effective.


Assuntos
Dor Abdominal/etiologia , Imunossupressores/uso terapêutico , Paniculite Peritoneal , Idoso , Azatioprina/uso terapêutico , Ciclofosfamida/uso terapêutico , Humanos , Masculino , Mesentério , Pessoa de Meia-Idade , Necrose/patologia , Paniculite Peritoneal/diagnóstico por imagem , Paniculite Peritoneal/tratamento farmacológico , Paniculite Peritoneal/cirurgia , Prednisona/uso terapêutico , Doenças Raras , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tripterygium
20.
Zhonghua Nei Ke Za Zhi ; 56(2): 157-160, 2017 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-28162192

RESUMO

A 32 year-old woman in the third trimester of pregnancy was admitted for severe acute pancreatitis due to hypertriglyceridemia. During hospitalization she developed multiorgan dysfunction, infected pancreatic necrosis, abdominal compartment syndrome and intrauterine fetal death. She was successfully treated by multidisciplinary team including department of emergency medicine, ICU, gastroenterology, obstetrics, endocrinology, ultrasonography, radiology, infectious disease, nutrition and surgery.


Assuntos
Dor Abdominal/etiologia , Hiperlipidemias/diagnóstico , Hipertrigliceridemia/complicações , Pancreatite/diagnóstico , Complicações na Gravidez/diagnóstico , Doença Aguda , Adulto , Feminino , Morte Fetal , Humanos , Insuficiência de Múltiplos Órgãos/etiologia , Pancreatite/etiologia , Gravidez , Terceiro Trimestre da Gravidez
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