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High-dose rate brachytherapy for palliative care in rectal cancer: A case with a complete response, followed by a rare complication 直肠癌姑息治疗的高剂量率近距离放疗:一例完全缓解,随后出现罕见并发症
Pub Date : 2019-01-01 DOI: 10.15761/ghe.1000178
Aurélia Alati, Leobon Sophie, C. Pierre
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引用次数: 0
An unusual cause of deranged liver function tests: From paracetamol to Pompe’s 肝功能检查异常的不寻常原因:从扑热息痛到庞培
Pub Date : 2019-01-01 DOI: 10.15761/ghe.1000182
R. Rajendram, R. Parker
AMD (glycogen storage disease type 2) or Pompe’s disease is an autosomal recessive disorder with an estimated incidence of approximately 1:40,000 [1,2]. There is a deficiency of the enzyme α1,4 glucosidase which breaks down glycogen in cell lysosomes. Glycogen accumulates within lysosomes and disrupts cellular function. This affects skeletal muscle including the diaphragm. The presentation is usually insidious with gradually increasing peripheral muscle weakness or respiratory failure. Prognosis is highly variable and depends on the gene mutation and enzyme activity. As no cure is available, supportive therapies such as noninvasive ventilation and genetic screening of family members are the cornerstones of management. However, enzyme replacement therapies have been developed and the results of initial studies are promising [3,4].
AMD(2型糖原储存病)或Pompe病是一种常染色体隐性遗传病,估计发病率约为1:40 000[1,2]。细胞溶酶体中分解糖原的α1,4葡萄糖苷酶缺乏。糖原在溶酶体内积聚,破坏细胞功能。这会影响包括横膈膜在内的骨骼肌。表现通常是隐匿的,逐渐增加周围肌肉无力或呼吸衰竭。预后是高度可变的,取决于基因突变和酶活性。由于无法治愈,支持性治疗,如无创通气和家庭成员的遗传筛查是管理的基石。然而,酶替代疗法已经发展起来,初步研究的结果很有希望[3,4]。
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引用次数: 0
Hospital zero hepatitis: Easy and useful! 医院零肝炎:简单实用!
Pub Date : 2019-01-01 DOI: 10.15761/GHE.1000180
Remy André-Jean
Introduction: 59000 hepatitis C patients were unknown or not followed in France. In 2017, 81% of our “new” patients have already been hospitalized, especially in emergency units. Hepatitis C was noted in their file as other medical histories like appendicitis or shin fracture! Drug users came one to twelve times per year in hospital for different reasons, but never for hepatitis care. No HCV care was proposed to these patients after other health problem resolution. Objective: To identify HCV patients coming to our hospital by using nurses of every service for a goal of zero hepatitis hospital. Methodology: Our hepatitis specialized nurse did training sessions of nurses in every unit of our hospital about hepatitis screening, diagnosis and treatment and when to call hepatitis nurse if they had HCV positive patient and gave specific flyers and posters. Results: In 15 months, hepatitis nurse did training sessions in 15 units of our hospital, including 92 nurses. We received 58 calls about 52 patients with hepatitis C; 50/58 patients were current or formers drug users, 32 patients are known as negative viral load, spontaneously or after antiviral treatment; 20 had positive viral load and took care by our team; 13 started immediately DAA. All drug users had also risk reduction session. Conclusion: Hospital nurses training was easy to set up and cheap and useful to detect new patients or known patients without medical care, specially drug users. Same project could be done in every hospital. *Correspondence to: Remy Andre-Jean, Mobile Hepatitis Team, Perpignan Hospital, France, Tel: 0468616137; E-mail: andre.remy@ch-perpignan.fr
简介:法国59000名丙型肝炎患者未知或未随访。2017年,我们81%的“新”患者已经住院,特别是在急诊室。在他们的档案中,丙型肝炎被记录为其他病史,如阑尾炎或胫骨骨折!吸毒者每年因各种原因来医院一到十二次,但从来没有因为肝炎治疗。在解决了其他健康问题后,这些患者未接受HCV治疗。目的:为实现医院零肝炎的目标,利用各科室护士对来我院就诊的HCV患者进行识别。方法:我院肝炎专科护士对我院各科室护士进行肝炎筛查、诊断和治疗培训,培训有丙肝阳性患者时何时呼叫肝炎护士,并发放针对性的传单和海报。结果:在15个月的时间里,我院肝炎护理人员参加了15个单位的培训,其中护士92人。我们接到58个电话,涉及52名丙型肝炎患者;50/58例患者为当前或既往吸毒者,32例患者为病毒载量阴性,自发或经过抗病毒治疗;20例病毒载量阳性,由我们团队照顾;13立即开始DAA。所有吸毒者还参加了降低风险会议。结论:医院护士培训设置简单,费用低廉,对发现新发患者或已知未就医患者,特别是吸毒人员有一定的帮助。同样的项目可以在每家医院进行。*通讯:法国佩皮尼昂医院流动肝炎小组Remy Andre-Jean,电话:0468616137;电子邮件:andre.remy@ch-perpignan.fr
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引用次数: 0
Endoscopic removal of impacted Dormia basket: The post-cut procedure 内窥镜切除嵌塞睡眠篮:切后手术
Pub Date : 2019-01-01 DOI: 10.15761/ghe.1000185
W. Ferjaoui, Mohamed Ali Chaouech, Wafa B Hmida, R. Bouali, W. Ghariani, H. Jerraya, R. Nouira
Endoscopic procedures are widely used for the management of bile duct stones. Pancreatitis, haemorrhage, cholangitis and intestinal perforation are the most commonly reported complications. Impaction of stone-retrieving devices such as Dormia basket is rare. It can be removed using a smaller basket, balloons, percutaneous transhepatic removal, laparoscopic retrieval or even through laparotomy. In our case, it was feasible and safe using the post cut technique which is a type of a second biliary sphincterotomy performed after a previous sphincterotomy in order to enlarge the papillary orifice and to extract the impacted Dormia basket. *Correspondence to: Wael Ferjaoui, Department of Surgery B23, Charles Nicolle Hospital, Tunisia, Tel: +216 52430099; E-mail: farjaouiwael4@gmail.com key words: common bile duct stone, impacted Dormia basket, post cut Received: July 15, 2019; Accepted: August 01, 2019; Published: August 05, 2019 Introduction Endoscopic management is the first line therapy of common bile duct stones [1]. In most cases, they are successfully extracted with Endoscopic Retrograde Cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) using a Dormia basket or balloon catheters [1]. This endoscopic treatment ensures less morbidity and mortality then surgery [1]. The most common complications of endoscopic treatment are pancreatitis, bleeding and perforation [2]. Recognizing other less common events like Dormia basket impaction is important in order to prevent disastrous outcomes. The aim of this article is to report a case of Dormia basket impaction that could be managed using an endoscopic technique called the post-cut procedure in order to prove its efficiency and safety.
内镜手术被广泛用于胆管结石的治疗。胰腺炎、出血、胆管炎和肠穿孔是最常见的并发症。像Dormia篮这样的取石装置的撞击是罕见的。它可以用一个较小的篮子,气球,经皮经肝切除,腹腔镜取出,甚至通过剖腹手术。在我们的病例中,使用后切技术是可行和安全的,这是在先前的括约肌切开术之后进行的第二次胆道括约肌切开术,以扩大乳头口并取出阻塞的Dormia篮子。*通讯:Wael Ferjaoui,突尼斯Charles Nicolle医院B23外科,电话:+216 52430099;关键词:胆总管结石;嵌塞性睡眠筐;剪后录用日期:2019年8月1日;内镜下管理是胆总管结石的一线治疗方法[1]。在大多数情况下,使用Dormia篮子或球囊导管,通过内镜逆行胆管造影(ERCP)和内镜括约肌切开术(ES)成功地取出它们[1]。与手术相比,内镜治疗的发病率和死亡率更低[1]。内镜治疗最常见的并发症是胰腺炎、出血和穿孔[2]。认识到其他不太常见的事件,如Dormia篮子撞击,对于防止灾难性后果很重要。本文的目的是报告一例Dormia篮嵌塞,可以使用内窥镜技术进行治疗,称为切后手术,以证明其效率和安全性。
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引用次数: 2
A rare cause of abdominal pain in a child: Mesenteric panniculitis 一种罕见的引起儿童腹痛的原因:肠系膜性肠膜炎
Pub Date : 2019-01-01 DOI: 10.15761/ghe.1000181
Ishak Abdurrahman Isik
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引用次数: 0
Severe hepatopathy and celiac disease 严重肝病和乳糜泻
Pub Date : 2019-01-01 DOI: 10.15761/GHE.1000175
M. Firwana, I Benelberhdadi, A Aomari, Ajana Fz
Of a total of 248 cases of celiac disease observed in our department, 78 cases (31.5%) had chronic associated liver disease, including 05 cases of severe liver disease. There are 3 women and 2 men with a sex ratio F/H of 1.5, the average age was 35 years [25-57]. The diagnosis of celiac disease was made before the appearance of chronic liver disease in 04 patients with an average delay of 9.5 years, whereas only one patient had a chronic liver disease diagnosed 05 years before the discovery of celiac disease. The reason for consultation was mainly malabsorption diarrhoea (5 cases). The physical examination found a syndrome of portal hypertension in 3 cases and is normal in 2 cases. In the biology, there was anaemia in 4 cases including one case of pan cytopenia, one hepatic cytolysis in 4 cases. The abdominal ultrasound showed a chronic hepatic appearance +/sign of HTP in 4 cases and normal in one case. The etiological balance of cytolysis was negative (B, C, autoimm, overload). Upper digestive endoscopy showed a rarefaction of duodenal folds in 3 cases, with signs of HTP in all patients. The histopathological study of the biopsies showed intraepithelial lymphocytosis > 30% with villous atrophy in all patients. Antitransglutaminase antibodies were positive in 04 patients and negative in 01 cases. The liver biopsy puncture showed severe fibrosis (F3) in 03 cases and cirrhosis (F4) in 2 cases. All our patients are on gluten-free diet, with symptomatic treatment of portal hypertension. The evolution was marked by a stabilization of chronic liver disease and its complications. One case presented ascitic decompensation for poor compliance with the glutenfree diet. No case of CHC has been noted in our series.
我科共收治248例乳糜泻患者,合并慢性相关肝病78例(31.5%),其中重度肝病05例。女性3名,男性2名,性别比F/H为1.5,平均年龄35岁[25-57]。在慢性肝病出现之前诊断为乳糜泻的患者有04例,平均延迟9.5年,而在发现乳糜泻前05年诊断为慢性肝病的患者只有1例。就诊原因以吸收不良腹泻为主(5例)。体格检查发现门静脉高压症3例,正常2例。生物学上有贫血4例,其中泛细胞减少1例,肝细胞溶解1例。腹部超声显示慢性肝样+ HTP征象4例,正常1例。细胞溶解的病因平衡为负(B, C,自动机,过载)。上消化道内窥镜检查显示3例十二指肠皱襞缩小,所有患者均有HTP征象。组织病理学检查显示所有患者上皮内淋巴细胞增多> 30%,绒毛萎缩。抗转谷氨酰胺酶抗体阳性04例,阴性01例。肝活检穿刺显示严重纤维化(F3) 03例,肝硬化(F4) 2例。所有患者均采用无谷蛋白饮食,对症治疗门静脉高压症。这种演变的特点是慢性肝病及其并发症的稳定。一例出现腹水失代偿不良依从无谷蛋白饮食。本系列文献中未发现CHC病例。
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引用次数: 0
Increased liver tests and hepatomegaly: Is there an increased prevalence of Gaucher disease in this population? 肝检查增加和肝肿大:戈谢病在这一人群中的患病率是否增加?
Pub Date : 2019-01-01 DOI: 10.15761/ghe.1000173
Elkilic O, Laeremans H, Lasser L, Mboti F
The screening was performed using a dried bloodspot on Whatman paper 906. The enzymes were measured with a LC-MS-MS method according to the protocol of CDC (Centre of disease control and prevention). The method was validated for stability of the enzymes in the dried blood spot and variability. All runs were controlled with external controls from CDC and blanc correction was adapted. Cut-off values were 3 umol/l/h has been proposed and used by the reference center.
使用Whatman 906纸上的干血点进行筛选。酶的测定采用LC-MS-MS法,按照美国疾病控制与预防中心的规程进行。验证了该方法在干血斑中酶的稳定性和变异性。所有运行均采用CDC的外部控制,并采用blanc校正。截止值为3umol /l/h,已被参考中心采用。
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引用次数: 0
A seriously overlooked hemorrhage following paracentesis managed by trans-arterial embolization of the deep circumflex iliac artery: A case report 经动脉栓塞治疗旋髂深动脉穿刺后严重被忽视的出血:一例报告
Pub Date : 2019-01-01 DOI: 10.15761/ghe.1000174
M. Habib, M. Hillis, Khaled Hani Alkhodari
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引用次数: 0
Motivators, barriers and incidence of screening for celiac disease in first degree relatives at 14 years after initial screening 首次筛查后14年一级亲属乳糜泻筛查的动机、障碍和发病率
Pub Date : 2019-01-01 DOI: 10.15761/ghe.1000179
Anne R Lee, S. Keats, R. Wolf, B. Lebwohl, E. Ciaccio, P. Green
Background: The prevalence of celiac disease (CD) is nearly 1% of the general population, but higher among first-degree relatives. Current guidelines recommend testing for symptomatic first-degree relatives and consideration of testing for asymptomatic first-degree relatives. We sought to determine incidence of follow-up testing, as well as facilitators and barriers, in first-degree relatives who participated in a Family Screening Day 2005. Method: The 272 first-degree relatives who provided initial contact information were invited to participate in this study. A self-administered questionnaire queried retesting, conversion, additional diagnosis, and relationship to the index family member. Data was analyzed using descriptive statistics. Results: Responses (n=34, 13% of the originally screened cohort) were received, 17 participants met inclusion criteria and completed the survey. The participants were predominately female (71%) and between the ages of 26-55 (59%) at follow-up. Thirteen (77%) of the 17 participants tested negative in 2005. The majority (N=9, 69%) of those initially testing negative had not been retested nearly 14 years later. Barriers to retesting were the belief that retesting was not necessary (78%) and lack of symptoms (22%). Presence of symptoms were a motivating factor for the 3 of the four individuals who did retest (75%). Conclusion: We found a low rate of retesting of first-degree relatives despite recommendations. In the light of increased incidence of celiac disease in first-degree relatives, as well as the increased risk of developing comorbidities if celiac disease is left untreated, the results of this study indicate the need for increased awareness of testing recommendations among first-degree relatives. *Correspondence to: Anne R Lee, Celiac Disease Center, Columbia University Irving Medical Center, Harkness Pavilion, 180 Fort Washington Avenue, New York, NY, USA, Tel: (212) 305-5590; E-mail: arl2004@cumc.columbia.edu
背景:乳糜泻(CD)的患病率接近总人口的1%,但在一级亲属中更高。目前的指南建议对有症状的一级亲属进行检测,并考虑对无症状的一级亲属进行检测。我们试图确定参加2005年家庭筛查日的一级亲属中随访检测的发生率,以及促进因素和障碍。方法:邀请272名提供初次联系方式的一级亲属参与本研究。一份自我管理的问卷询问了重新检测、转换、附加诊断以及与索引家庭成员的关系。数据分析采用描述性统计。结果:收到回复(n=34,占原始筛选队列的13%),17名参与者符合纳入标准并完成了调查。参与者主要是女性(71%),随访时年龄在26-55岁之间(59%)。2005年,17名参与者中有13人(77%)检测呈阴性。大多数(N= 9,69%)最初检测为阴性的患者在近14年后没有再次检测。重新检测的障碍是认为没有必要重新检测(78%)和缺乏症状(22%)。症状的存在是重新测试的4个人中的3个(75%)的激励因素。结论:尽管有建议,我们发现一级亲属的复检率很低。鉴于乳糜泻在一级亲属中的发病率增加,以及如果乳糜泻得不到治疗,发生合并症的风险增加,本研究的结果表明需要提高一级亲属对检测建议的认识。*通信:Anne R Lee,腹腔疾病中心,哥伦比亚大学欧文医学中心,哈克尼斯馆,华盛顿堡大道180号,纽约,NY,美国,电话:(212)305-5590;电子邮件:arl2004@cumc.columbia.edu
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引用次数: 0
Autoimmune diseases associated with autoimmune hepatitis in a series of 21 cases 自身免疫性疾病伴自身免疫性肝炎21例
Pub Date : 2019-01-01 DOI: 10.15761/ghe.1000191
Bennani Gk, Benelbarhdadi I, Bourehma M, Berhili C, Lagdali N, Ajana Fz
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引用次数: 0
期刊
World journal of gastroenterology, hepatology and endoscopy
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