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INTERVENTION OF RARELY SEEN CATHETER LOSS DURING PERMANENT TUNNELED HEMODIALYSIS CATHETERIZATION: A CASE REPORT 永久性隧道式血液透析置管中罕见导管丢失的干预1例
Pub Date : 2020-06-21 DOI: 10.24125/sanamed.v15i2.425
Emced Khalil
Introduction: In patients with end-stage renal disease (ESRD), permanent hemodialysis cathetersare often used by performing percutaneous catheterization to create a permanent vascular access. To the best of our knowledge, no cases with accidental loss of catheter piece during hemodialysis catheter replacement or during its retrieval under scopy has been reported in the literature yet. Case report: It was decided to retrieve the right permanent dialysis catheter of a 54-year-old woman, who had received a temporary dialysis catheter due to the development of catheter site infection in her 3 rd permanent catheter (the first two were changed due to thrombosis). Due to excess adhesion in the region, the retrieval of the catheter was complicated, only half of it (proximal piece after cutting into two) was removed, while the distal section slipped and migrated to the right subclavian vein, up to the right atrium.The diagnosis was confirmed by chest radiographs showing that the distal piece of the catheter piece was in the right subclavian vein and right atrium. The catheter piece was retrieved through a minor invasive procedure made possible by scopy without any further complications. Conclusion : Permanent dialysis catheters should ideally be placed under scopy. Also, when the retrieval of a catheter is planned, cutting from any part of the catheter should never be performed.
引言:在终末期肾病(ESRD)患者中,永久性血液透析导管通常通过进行经皮导管插入术来创建永久性血管通路。据我们所知,文献中尚未报道在血液透析导管更换过程中或在镜检下取出导管时导管片意外丢失的病例。病例报告:决定取回一名54岁女性的右侧永久性透析导管,该女性因第3根永久性导管中的导管部位感染而接受了临时透析导管(前两根因血栓形成而更换)。由于该区域的过度粘连,导管的取出很复杂,只有一半(切成两半后的近端)被取出,而远端部分滑动并转移到右锁骨下静脉,直到右心房。胸部X线片显示导管片的远端位于右锁骨下静脉和右心房,从而证实了诊断。导管片是通过微创手术取出的,该微创手术通过镜检实现,没有任何进一步的并发症。结论:理想情况下应将永久性透析导管置于镜下。此外,当计划取回导管时,不得从导管的任何部分进行切割。
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引用次数: 0
ATRIAL FIBRILATION AND GAMA GLUTAMYL TRANSFERASE; OF-PUMP VERSUS ON-PUMP CORONARY ARTERY BYPASS SURGERY 心房原纤维形成和γ-谷氨酰转移酶;体外循环与体外循环冠状动脉搭桥术
Pub Date : 2020-06-17 DOI: 10.24125/sanamed.v15i2.440
Emced Khalil
Introduction: Atrial fibrillation (AF) which can be seen as a complication of the open heart surgery, may  cause serious problems on post operative period. The exact pathophysiology of AF is unknown but it is thought that factors such as oxidative stress might cause AF. Material and methods : We retrospectivily surveyed the serum gamma glutamyl transferase (GGT) levels which is accepted as a mediator of oxidative stres, for the Post Operative Atrial Fibrillation (POAF) that occur after of-pump versus on-pump Coronary Artery Bypass Graft (CABG) surgery. Our study included 183 cases ( 101 male, 72 female; median age 63 ± 4.3 years) of which CABG was performed. Results: Echocardiography, routine blood tests, electrocardiography (ECG), test for the serum GGT levels were performed in preoperative and postoperative  period to all participants. AF developed  in 34 patients (35 %) in Group I and 19 patients (20 %) in Group II. There were no significant differences between two groups (of-pump versus on-pump) in terms of gender, cardiovascular risk factors and the severity of the coronary artery disease. In patients who has developed AF in postoperative period had significantly higher serum GGT levels. Conclusion : This study has shown that serum GGT levels were found to be significantly higher in patients whom AF has developed after on-pump CABG surgery.
心房颤动(AF)是心脏直视手术的并发症之一,在术后可能会引起严重的问题。房颤的确切病理生理机制尚不清楚,但人们认为氧化应激等因素可能导致房颤。材料和方法:我们回顾性调查了被认为是氧化应激介质的血清谷氨酰转移酶(GGT)水平,这是发生在无泵和无泵冠状动脉旁路移植术(CABG)术后房颤(POAF)的中介。本研究纳入183例病例,其中男性101例,女性72例;中位年龄63±4.3岁),其中行CABG。结果:所有受试者术前、术后均行超声心动图、血常规、心电图、血清GGT水平检测。第1组34例(35%)发生房颤,第2组19例(20%)发生房颤。在性别、心血管危险因素和冠状动脉疾病的严重程度方面,两组(使用泵和不使用泵)之间没有显著差异。术后发生房颤的患者血清GGT水平明显增高。结论:本研究表明,非泵式冠脉搭桥术后发生房颤的患者血清GGT水平明显升高。
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引用次数: 0
A WORD FROM THE EDITOR 编辑的一句话
Pub Date : 2020-05-27 DOI: 10.24125/sanamed.v15i1.434
Avdo Ceraninc
This year has been filled with emotions of all types; kind of a roller coaster ride and unfortunately we still have a bit left of that ride. For most of us, it has been a difficult year where we have had to adapt and reinvent ourselves to a certain degree. This applies very much to this magazine and before anything else I would like to show my gratitude to the SFPE staff, the editorial board, and all you readers out there. Without all of you, we would not have the success we have; we are sharing knowledge in its true sense.
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引用次数: 0
THROMBOTIC THROMBOCYTOPENIC PURPURA: A CASE REPORT AND REVIEW OF LITERATURE 血栓性血小板减少性紫癜1例报告及文献复习
Pub Date : 2020-05-27 DOI: 10.24125/sanamed.v15i1.382
S. Stankovikj
Introduction :  Thrombotic thrombocytopenic purpura (TTP) is a syndrome that consists of the pentad of thrombocytopenia, microangiopathic hemolytic anemia, neurologic abnormalities, fever and renal disease.  Moskowitz was the first who described this syndrome in 1925, finding hyaline thrombi in many organs. The micro thrombi cause tissue ischemia, platelet consumption, and microangiopathic hemolytic anemia. Brain involvement is common and leads to stroke, seizure, confusion, and headache. Renal injury occurs in a minority of patients and it is usually modest. Case report :  We present a 57-year old male who came to our hospital because of weakness, prostration and darkening of his urine, occurring several days before admission. On physical examination we found icteric coloring of his skin and conjunctiva, big hematoma on his right lower leg and he had neurological abnormalities presented as mild headache, disorientation and aphasia. Laboratory tests revealed anemia and thrombocytopenia and the examination of peripheral blood smear showed presence of schistocytes.  Direct and indirect antiglobulin test (Coombs) was negative. Emergency treatment was started with plasmapheresis on daily basis, immunosuppressive treatment with high-dose methyl prednisolone and transfusions of red blood cells. The laboratory results and the clinical condition improved within two weeks. Conclusion : TTP is a medical condition that can be fatal if emergency treatment with plasma pheresis is not initiated presently after suspected diagnosis.
简介:血栓性血小板减少性紫癜(TTP)是一种由血小板减少症、微血管致病性溶血性贫血、神经系统异常、发热和肾脏疾病五种症状组成的综合征。莫斯科维茨是1925年第一个描述这种综合征的人,他在许多器官中发现了透明血栓。微血栓引起组织缺血、血小板消耗和微血管性溶血性贫血。大脑受累是常见的,可导致中风、癫痫、意识不清和头痛。肾损伤发生在少数患者,它通常是温和的。病例报告:我们报告一名57岁男性患者,在入院前几天因虚弱、虚脱和尿色变而来我院就诊。在体检中,我们发现他的皮肤和结膜呈黄疸色,右小腿有大血肿,他有神经系统异常,表现为轻度头痛,定向障碍和失语。实验室检查显示贫血和血小板减少症,外周血涂片检查显示存在血吸虫细胞。直接和间接抗球蛋白试验(Coombs)阴性。紧急治疗开始于每日血浆置换、大剂量甲基强的松龙免疫抑制治疗和输注红细胞。实验结果和临床情况在两周内得到改善。结论:TTP是一种医学疾病,如果在怀疑诊断后不立即进行血浆穿刺治疗,可能会致命。
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引用次数: 0
THROMBOPHLEBITIS OF PREPUBIC VEINS IN PATIENTS WITH APLASIA OF THE LEFT COMMON AND LEFT EXTERNAL ILIAC VEINS-CASE REPORT 左总静脉和左髂外静脉发育不全患者的耻骨前静脉血栓性静脉炎1例报告
Pub Date : 2020-05-27 DOI: 10.24125/sanamed.v15i1.376
Bogdan Crnokrak, Darko Zdravkovic, B. Tošković, N. Colakovic
Introduction: A congenital defect of some of the large veins that drain blood from the lower extremity is a very rare occurrence and, considering the clinical consequences, it is generally diagnosed at a relatively early age - in childhood or youth. Within the complex classification of vascular malformations, a special category is comprised of large blood vessel malformations, also called truncal vascular malformations. In comparison to other anomalies, aplasia or lack of development of a certain segment in the deep venous systems, potentially has the most serious hemodynamic consequences. The appearance of varicose veins, through which the venous blood is drained distally to the obstruction into an unusual area, such as the lower part of the trunk or the anterior abdominal wall, usually spurs the patient into action in terms of conducting diagnostic procedures so that diagnosis can be reached before complications occur. Defects of large magistral deep veins, which remain unrecognized until adulthood and which are diagnosed after complications in the drainage venous network occur, are infrequent. Complications that can arise in association with this malformation are manifested not only in varicosally altered collateral veins, but also in the venous drainage area distal to the obstruction. Case report: We hereby present a case of a patient admitted to hospital with a clinical picture and an ultrasound finding indicating an incarcerated inguinal hernia. During surgery, thrombophlebitis of extremely dilated prepubic veins was established. Subsequent diagnostic procedures revealed the presence of a rare vascular anomaly - aplasia of the left common andleft external iliac veins. Under the mentioned conditions, a collateral venous network developed in both groins and the prepubic region, draining blood from the left leg into the right common femoral vein.
引言:从下肢排出血液的一些大静脉的先天性缺陷是非常罕见的,考虑到临床后果,它通常在相对较早的时候被诊断出来——在儿童或青少年时期。在血管畸形的复杂分类中,有一个特殊类别是大血管畸形,也称为干血管畸形。与其他异常相比,深静脉系统中某一节段发育不全或缺乏发育,可能会产生最严重的血液动力学后果。静脉曲张的出现通常会促使患者采取行动,进行诊断程序,以便在并发症发生之前进行诊断。大法官深静脉的缺陷,直到成年才被识别,并且在引流静脉网出现并发症后被诊断出来,这种缺陷很少出现。与这种畸形相关的并发症不仅表现在静脉曲张改变的副静脉,也表现在阻塞远端的静脉引流区。病例报告:我们在此报告一例入院的患者,其临床照片和超声检查结果显示腹股沟疝嵌顿。在手术过程中,形成了极度扩张的包皮静脉血栓性静脉炎。随后的诊断程序显示了一种罕见的血管异常——左侧髂外总静脉和左髂外静脉发育不全。在上述条件下,腹股沟和耻骨前区域都形成了侧支静脉网,将左腿的血液排入右股总静脉。
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引用次数: 1
ACUTE AND CHRONIC PROSTATITIS 急慢性前列腺炎
Pub Date : 2020-05-27 DOI: 10.24125/sanamed.v15i1.319
G. Smieško
Today is very well known that prostatitis is often disease in men in the age of 50 and also it make a 1/3 of urological diseases in men over 50 year old, following benign glandular prostatic hyperplasia as well cancer of prostata. Acute bacterial prostatitis: Disturbed disorders are: general weakness, fever, pain or feeling of discomfort between the spine and the scrotum or the end of the colon, and frequent, painful and difficult urination is observed. Acute bacterial prostatitis most commonly occurs in men between the ages of 20 and 40. Disturbed disorders are: general weakness, fever, pain, or feeling of discomfort between the anus and the scrotum or in the end of the colon. In addition to the above symptoms, frequent, painful and difficult wetting occurs, and sometimes the urinary incontinence can occur. In case of suspected acute prostatitis, a prostate examination in the finishing section of the colon should be performed. The prostate is extremely painful on the touch, warm and sometimes "wet" consistency. In some cases, manure accumulation can occur within the prostate tissue, which leads to abscess (crowding), which should be surgically opened and emptied of purulent contents. Chronic bacterial prostatitis : Due to the presence of bacteria in the tissue of the prostate, chronic bacterial prostatitis is associated with frequent recurrent acute cystitis, or inflammation of the bladder mucous membrane. In this disease, patients are mostly free from the acute phase of worsening condition.
今天我们都知道前列腺炎是50岁男性的常见病50岁以上男性泌尿系统疾病中有1/3是前列腺炎,其次是良性腺体前列腺增生和前列腺癌。急性细菌性前列腺炎:紊乱症状为:全身无力、发热、脊柱与阴囊或结肠末端之间疼痛或不适感,尿频、尿痛、尿难。急性细菌性前列腺炎最常见于20至40岁的男性。紊乱性疾病有:全身无力、发热、疼痛或肛门与阴囊之间或结肠末端的不适感。除上述症状外,还会出现尿频、疼痛和尿湿困难,有时还会出现尿失禁。如果怀疑患有急性前列腺炎,应在结肠末端进行前列腺检查。前列腺摸起来非常痛,温暖,有时“湿”的稠度。在某些情况下,粪便积聚可发生在前列腺组织内,导致脓肿(拥挤),应通过手术打开脓肿并排空脓性内容物。慢性细菌性前列腺炎:由于前列腺组织中存在细菌,慢性细菌性前列腺炎与频繁复发的急性膀胱炎或膀胱粘膜炎症有关。在这种疾病中,患者大多没有病情恶化的急性期。
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引用次数: 1
THE TREATMENT OF ACUTE POISONING IN CLINICAL EMERGENCY CENTER OF KRAGUJEVAC 克拉古耶瓦茨临床急救中心急性中毒的救治
Pub Date : 2019-10-13 DOI: 10.24125/SANAMED.V14I3.359
Z. Kovačević, Vesna Marjanović, Katarina M. Janicijevic
To the Editor, All acute poisonings represent urgent conditions in medicine, no matter what clinical features are. Patients with acute poisoning make 3-5% of the total number of patients treated in emergency medical services "poisoning", and can be accidental, suicidal and murderous. Making (providing) accurate diagnosis is often difficult because it implies the identification of poison; that is not always possible of auto and heteroanamnesis data, physical examination (checkup) of the patient, and clinical symptoms of poisoning are used for making the diagnosis (1). Patient with symptoms of acute poisoning is immediately taken in emergency room where doctor specialist of emergency medicine or doctor specialist of internal medicine undertakes medical examination which implies: fast estimation of need for respiratory support and mechanical ventilation, or cardiorespiratory reanimation; monitoring of vital functions; measuring of arterial blood pressure, heart rate, arterial oxygen saturation by pulse-oximetry, electrocardiographic record of heart rate, x-ray lung recording; consultations with neurologist, surgeon, neurosurgeon, psychiatrist, or if it is necessary with doctors of other specialties; provision of venous line; applying of intravenous saline solution or intravenous sugar solution(dextrose solution); taking blood samples urgently; according to estimation testing blood on methyl-alcohol or ethyl-alcohol, or testing urine on psychoactive substances; estimation of consciousness; identification of signs of external physical injuries; nasogastric intubation in case of acute peroral poisoning except in case of poisoning by corrosive substances (acids, bases) when there are contraindications; this procedure is repeated until the stomach contents are clear after that activated carbon is given to a patient (2). If a patient is unconscious, the one needs to be intubated in order to protect the airways. After that nasogastric intubation is being done, after all activated carbon is given to a patient; if a patient is conscious and the collaboration can be established, the vomiting is caused by drinking hot water and after that activated carbon is given to a patient; after initial treatment in resuscitation room patients who are respiratory at risk (affected) of who have disturbances of consciousness are hospitalized in stationary rooms of Clinical Emergency Center, and those who have symptoms of light poisoning, they are taken in internist ambulance for observation and psychiatrist is consulted about the clinical conditions of them (3). The poisoning time of observation is estimated on the stabilization of vital parameters, improving the state of consciousness, as well, as the development of possible complications depending on the time of ingestion, type of toxic substance, the time of reporting poisoning to doctors and present co-morbidity. Antidote therapy is used for poisoning in which it is indicated. Atropine® is used for poisoning by organo-p
每一位被有机磷杀虫剂类化合物中毒的患者都要遵守上述急性中毒方案(4)。如果患者的临床状况是特定的,则有可能采集患者的血液,并将其送往贝尔格莱德军事医学院毒理学实验室进行分析。如果可能的话,采取生物材料(尿液、血液、灌洗液)来证明(证实)毒药及其代谢物(这可能是法庭上的重要证据)。针对这些中毒的具体治疗方法是:每五分钟静脉注射1至2mg剂量的阿托品®,直到出现高度阿托品化的迹象(肺部干燥、皮肤和口腔干燥、心动过速、面部(潮红)发红、瞳孔散大,剂量随临床特征而减少,到目前为止存在胆碱能危象的迹象;胆碱酯酶的再激活剂(激励剂)(肟类化合物-解磷定,剂量为1g,在前48小时内每4-6小时在盐溶液中静脉注射或肌肉注射一次,通常给患者服用7天);地西泮®(每8小时静脉注射10 mg的抗惊厥药,其目的是防止积聚的乙酰胆碱引起的惊厥作用);症状和支持性治疗(纠正酸碱和电解质失衡)(5)。血液透析在急性中毒中的作用已成为急性中毒不可或缺的治疗手段。
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引用次数: 0
FREQUENCY OF DISEASES PRESENTING IN ENT OPD AT AYUB TEACHING HOSPITAL ABBOTTABAD 阿伯塔巴德ayub教学医院耳鼻喉科出现疾病的频率
Pub Date : 2019-08-04 DOI: 10.24125/SANAMED.V14I2.315
Shahbaz Qayyum, S. Fayyaz
Introduction : Patient presents with ear, nose and throat diseases in ENT OPD to otolaryngologist/ENT specialist. ENT diseases are serious public health problems because of their universal distribution the morbidities which they cause due to inherent physiological function that take place in head and neck region. Objectives of our study were to know frequency of ENT diseases in patients presenting at ENT OPD at Ayub Teaching Hospital Abbottabad. Methods: A cross sectional study was done in Ayub Teaching Hospital Abbottabad from December 2015. to August 2016. Patients presenting at ENT OPD of Ayub Teaching Hospital Abbottabad were selected for study. Data about their ENT problems and concerned information were collected from them through well structured questionnaire. Data after collection was entered and analysed using SPSS-16. Results: The minimum age is 1 and maximum age is 80 years. Out of total 250 patients, 129 (51.6%) were males and 121(48.4%) were females, majority of patients 181 (72.4%) were from Abbottabad   and majority of patients 165(66.0%) were poor. The most common cases in ENT OPD were bilateral ear wax 15.2% followed by acute otitis media 13.2% and allergic rhinitis 13.2%. Conclusion: It is concluded from our research that most common problems of ENT disorders are bilateral ear wax, allergic rhinitis, acute otitis media, chronic supporative otitis media and deviated nasal septum. The most common causes are infection, poor hygiene and poor nutrition.
患者在耳鼻喉科向耳鼻喉科专家提出耳鼻喉科疾病。耳鼻喉科疾病分布普遍,其发病是由于头颈部固有的生理功能所致,是严重的公共卫生问题。我们研究的目的是了解在阿伯塔巴德Ayub教学医院耳鼻喉科就诊的患者患耳鼻喉科疾病的频率。方法:2015年12月在阿伯塔巴德Ayub教学医院进行横断面研究。至2016年8月。选取阿伯塔巴德Ayub教学医院耳鼻喉科就诊的患者作为研究对象。通过结构合理的问卷调查收集患者的耳鼻喉科问题及相关信息。采集后的数据输入并使用SPSS-16进行分析。结果:最小年龄为1岁,最大年龄为80岁。250例患者中,男性129例(51.6%),女性121例(48.4%),多数患者181例(72.4%)来自阿伯塔巴德,多数患者165例(66.0%)为穷人。耳鼻喉科最常见的是双侧耳垢15.2%,其次是急性中耳炎13.2%,变应性鼻炎13.2%。结论:耳鼻喉科疾病最常见的问题是双侧耳垢、过敏性鼻炎、急性中耳炎、慢性支配性中耳炎和鼻中隔偏曲。最常见的原因是感染、卫生条件差和营养不良。
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引用次数: 2
COMPARISON OF SURGICAL TREATMENT RESULTS AND CLINICAL AND RADIOLOGICAL FINDINGS OF TIBIAL PLATEAU FRACTURES 胫骨平台骨折手术治疗结果与临床及放射学表现的比较
Pub Date : 2019-08-04 DOI: 10.24125/SANAMED.V14I2.310
L. Kehribar, Levent Karapınar
Introduction : In this retrospective study, it was aimed to evaluate the correlation between operative treatment results and clinical and radiological findings of tibial plateau fractures. Patients and Methods: Between 1996 and 2006, 33 knees were operated for tibia plateau fracture of 32 patients. 29 patients were male and 3 were female. Only 3 cases (9.99%) were open tibial plateau fractures. The mean age was 45 years. Fractures classified using the Schatzker classification were: 17 (52%) type 1, 12 (12%) type 2, 9 (27%) type 5 and 6 (9%) type 6. Patients following the period were at least 44 weeks and maximum 480 weeks (mean 60 weeks). Results : The results of 33 patients were determined by the clinical and radiological system of Rasmussen. According to clinical findings, 17 cases were excellent, 9 were good, 6 were medium and 1 was poor. According to the radiological findings, 9 cases were excellent, 16 were good, 6 were medium and 2 were bad. The difference between clinical and radiological findings was analyzed with Pearson core analysis and statistically significant (p 0.005). The analyzes of the grade of fracture and the degree of fracture were statistically significant (p <0.005). 42.4% of all patients had meniscus injury. Therefore, arthroscopy should be used with surgery. Conclusion: Anatomic reduction, rigid fixation of the joint and early mobilization can reduce complications and improve the function of the knee joint in tibial plateau fractures.
引言:在这项回顾性研究中,旨在评估胫骨平台骨折的手术治疗结果与临床和放射学表现之间的相关性。患者与方法:1996~2006年,对32例胫骨平台骨折患者33膝进行手术治疗。男性29例,女性3例。开放性胫骨平台骨折3例(9.99%)。平均年龄45岁。使用Schatzker分类法分类的骨折为:17(52%)1型、12(12%)2型、9(27%)5型和6(9%)6型。术后患者至少44周,最长480周(平均60周)。结果:33例患者的结果均由Rasmussen的临床和放射学系统确定。根据临床表现,优17例,良9例,中6例,差1例。根据放射学表现,优9例,良16例,中6例,差2例。临床和放射学检查结果之间的差异用Pearson核心分析进行分析,具有统计学意义(p 0.005)。骨折等级和骨折程度的分析具有统计意义(p<0.005)。42.4%的患者有半月板损伤。因此,关节镜检查应与手术配合使用。结论:解剖复位、关节固定牢靠、早期活动可减少并发症,改善胫骨平台骨折膝关节功能。
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引用次数: 2
CHOLEDOCHOCELE WITH RECURRENT PANCREATITIS-CASE REPORT 胆总管囊肿合并胰腺炎复发1例
Pub Date : 2019-08-04 DOI: 10.24125/SANAMED.V14I2.306
F. Ateş, Turgay Kara, H. Sara, Muhammed Sami Çoban, M. Durmaz, Fatih Dal
Choledochal cysts are an uncommon anomaly of unknown etiology of the bilious system. This anomaly, characterized by cystic dilatations on intrahepatic or extrahepatic bile ducts, can be seen at any age from birth. Most rare congenital bile duct cysts choledochocele (type III) is usually diagnosed in adults. Since the congenital choledochal cyst has not a unique clinical finding, the basic criteria for diagnosis are based on imaging findings. This article presents a case of choledochoceleaccompanying.recurrent pancreatitis in a 19-year-old male patient.
胆总管囊肿是一种罕见的异常原因不明的胆道系统。这种以肝内或肝外胆管囊性扩张为特征的异常,可以在出生后的任何年龄看到。大多数罕见的先天性胆管囊肿胆总管囊肿(III型)通常被诊断为成人。由于先天性胆总管囊肿没有独特的临床表现,诊断的基本标准是基于影像学表现。本文报告一例胆碱巧克力伴发症。复发性胰腺炎1例19岁男性患者。
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引用次数: 0
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Sanamed
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