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Objective:To review the etiology, clinical manifestations, cranial MRI features and outcome of alcoholic and non-alcoholic Wernicke′s encephalopathy (WE).Methods:The clinical data of 51 WE patients admitted in Peking Union Medical College Hospital from May 1999 to May 2019 were retrospectively analyzed, including 10 cases of alcoholic WE (19.6%) and 41 cases of non-alcoholic WE (80.4%). The clinical manifestations, MRI results, treatment and efficacy of the two groups were compared.Results:The gastrointestinal surgery (17.1%, 7/41) , biliary and pancreatic diseases (14.6%, 6/41) , malignancy (12.2%, 5/41) were the common causes of non-alcoholic WE. Only 39.2% (20/51) of WE patients had typical triad syndrome of mental disorders, ocular symptoms and ataxia. There was no significant difference in the proportion of patients with typical triad syndrome between alcoholic WE and non-alcoholic WE groups [5/10 vs. 36.6% (15/41) , χ 2=0.959, P=0.619]. Mental disorders were more common in non-alcoholic WE [95.1% (39/41) vs. 70.0% χ 2=5.738, P=0.017]. In 45 WE patients undergoing cranial MRI, 53.3% (24/45) had typical symmetry abnormal signals in bilateral thalamus, periaqueductal region and paraventricular region of the third ventricle, in which non-alcoholic WE was more likely to have atypical lesions in comparison with alcoholic WE [66.7% (14/21) vs. 1/3, χ 2=10.578, P=0.001]. Forty-nine patients were treated with vitamin B 1 during hospitalization and symptoms were improved in 91.8% (45/49). The response to vitamin B 1 in non-alcoholic WE was better than that in alcoholic WE [97.4% (38/39) vs. 7/10, χ 2=8.128, P=0.017]. Conclusions:Non-alcoholic Wernicke′s encephalopathy deserves clinical attention. Compared with alcoholic WE, non-alcoholic WE may present mental disorders more frequently, and is more likely to have atypical lesions in cranial MRI, and has better response to vitamin B 1 treatment. Early identification, diagnosis and supplementation of vitamin B 1 can improve the prognosis of WE.
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Objective To analyze the clinical characteristics of chronic intestinal pseudoobstruction (CIPO).Methods Clinical data of 43 patients with CIPO admitted in Peking Union Medical College Hospital from January 2012 to December 2016 were retrospectively reviewed.The clinical manifestations,laboratory examinations,images,treatment and prognosis of CIPO patients were analyzed.Results There were 14 males and 29 females with an mean age of (41.9 ± 16.1) years.Among 43 patients,32 were admitted in Gastroenterology Department,6 in General Medicine Department and 5 in Rheumatology Department.Twenty two cases were primary CIPO and 21 cases were secondary.The main clinical manifestations were abdominal distension (93.0％),abdominal pain (67.4％),vomiting (67.4％),diarrhea (46.5％) and constipation (41.9％).All 43 patients had decreased body weight and body mass index (BMI);23.3％ (10/43) patients were complicated with anxiety and depression.53.5％ (23/43) patients presented anemia and 55.8％ (24/43) patients presented hypoalbuminemia.All patients with CIPO underwent abdominal X-ray,which showed intestinal obstruction;but there was no evidence of mechanical obstruction.The average length of hospital stay was (28.4 ± 13.9) d.Twenty three cases underwent gastric decompression;28 cases (65.1％) received parenteral nutrition,and 21 cases (48.8％) received enteral nutrition;and 9 abdominal operations were performed in 8 patients.Conclusion When clinical symptoms of intestinal obstruction appear without mechanical cause,CIPO should be considered and secondary factors should be screened.Unnecessary surgery should be avoided in CIPO patients.
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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.
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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.
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Objective To investigate the predictors of deep remission in patients with Crohn′s disease (CD)treated with infliximab.Methods From February 2008 to February 2015 ,the clinical, laboratory and follow up data of 44 CD patients who received infliximab treatment and maintained clinical remission over six months were retrospectively analyzed.Mucosal healing was defined as no ulcer under endoscopy.Deep remission was defined as clinical remission with mucosal healing.According to results of endoscopy examination,the enrolled patients were divided into deep remission group and non-deep remission group.T test or Wilcoxon rank sum test was used for comparison of measurement data between groups,and chi square test was performed for the rate comparison.Multivariate analysis was made with Logistic regression.Results Median age of 44 patients was 19.5 yeares,39 males (88.6%),five females (11 .4%),and the median disease duration was 35 .0 months (18.5 to 73.5 months).Deep remission was achieved in 20 CD patients with long-time follow-up (median follow-up time 19 months,12 to 29 months). The mean duration of achieving deep remission was (28.9 ± 14.3 )weeks.There was no statistically significant difference between 20 patients with deep remission and 24 patients without deep remission in age of onset,disease duration,smoking status,Montreal phenotype,concurrent medications (mesalazine, steroids and azathioprine ), as well as body mass index (BMI ) and laboratory tests (erythrocyte sedimentation rate (ESR),high-sensitivity C-reactive protein (hsCRP),hemoglobin (Hb)and platelet (PLT)count)before administrating.The results of Logistic regression demonstrated that extraintestinal manifestations (arthralgia)(odds ratio (OR)=29.9,95 % confidence interval (CI )1 .26 -714.20,P =0.036),normalization of hs CRP at 14 th week after induced remission (OR=0.88,95 %CI 0.78-0.99, P =0.045)and thrombocytopenia (OR = 0.98,95 %CI 0.96 - 0.99,P = 0.016 )were independent predictive factors of deep remission.Conclusions Infliximab could effectively maintain long term deep remission in treatment of CD.Arthralgia,normalization of hsCRP and PLT counts at 14 th week after induced remission are predictive factor of deep remission.
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IgG4-related disease (IgG4-RD) has been proved to be associated with malignancy.The incidence and risk factors of malignancy development in IgG4-RD were not clear.Nine IgG4-RD patients with malignancies and 27 IgG4-RD control cases were analyzed for risk factors and clinical features.The incidence of malignancy in IgG4-RD was 3.3％,higher than age-controlled general population.Smoking history was significantly more common in patients with malignancies than in the control group (9/9 vs 16/27,P ＜ 0.05).A total of 6/9 malignancies occurred within the first year after the diagnosis of IgG4-RD.Colorectal,biliary and thyroid cancers were the leading types.Smoking history is a risk factor for IgG4-RD associated malignancy.Careful vigilance to monitor malignancy needs to be paid during follow-up.
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Objective To evaluate the impact of sequence on the quality of bowel preparation in patients with anesthesia for same-day sequential bidirectional endoscopy and propose the optimal procedural sequence.Methods Single center blinded randomized observational study.Sixty-five patients were randomized to either the gastroscopy-first group or the colonoscopy-first group.Bowel cleanliness according to Boston bowel preparation scale (BBPS) scores were evaluated,also done the propofol dosage,caecal intubation time,procedure duration and complications.Results The BBPS score of entire colon showed no difference (6.72 ± 1.34 vs.6.89 ± 1.50,P =0.638),but the BBPS of ileal-cecum portion was higher in the colonoscopy-first group (1.21 ±0.54 vs.1.55 ±0.73,P =0.035).The total procedure time,propofol dosage and complications were similar between the two groups.Conclusion The bowel cleanliness of ileal-cecum portion in colonoscopy-first group is better than that of gastroscopy-first group during sequential bidirectional endoscopy in patients with propofol sedation.We propose colonoscopy first in patients with suspicious ileal-cecum lesion.
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Objective To summarize the clinical features of the third portion of duodenum (PATD) for improving the understanding of PATD.Methods Sixteen cases with PATD in Peking Union Medical College Hospital(PUMCH) were retrospectively analyzed.Results The most common symptoms of PATD were upper abdominal pain(12/16),vomiting (9/16) and distention (7/16).On average,the disease had progressed 5.5 months (including 2.5 months of diagnostic workup) before the diagnosis was established.Patients with pathologically poorly differentiated PATD had shorter course of disease (6.5 vs 16.6 months,P =0.56) and lower chance of cancer-directed surgery (1/8 vs 6/8,P =0.04) than those with well differentiated PATD.The diagnostic rate was 11/14 by CT scan while only 2/7 by upper gastrointestinal radiography.Three cases were misdiagnosed as superior mesenteric artery syndrome by barium examination.Conclusions PATD should be considered in patients presenting upper abdominal symptoms with negative gastmendoscopy and barium examination.Overall,CT scan plays a pivotal role in diagnosing PATD.Making a correct diagnosis timely can improve the outcome of PATD patients,particularly,in those with poorly differentiated pathology.
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Objective To increase the understanding in protein-losing enteropathy (PLE).Methods Sixty-one PLE patients were enrolled in the study and the clinical characteristics, complicated disease, diagnosis and treatment were analyzed. Results The age of the patients was 16-77 (40±15)years, and the gender ratio was 35:26 (female: male). The main clinical manifestations were bilateral lower limb edema in 51 cases, ascites in 41 cases, bilateral pleural effusion in 23 cases, pericardial effusion in 13cases, abdominal pain in 16 cases and diarrhea in 33 cases. The prominent abnormality in laboratory examinations was hypoalbuminemia. The underlying diseases include systemic lupus erythematosus (SLE) in 28 cases, intestinal lymphangiectasia in 12 cases, hepatic cirrhosis in 5 cases, heart diseases in 5 cases,Crohn's disease in 3 cases, membranous nephropathy in 2 cases, Budd-Chiari syndrome in 1 case. Four cases happened after abdominal operation and 1 case after radiation therapy of gastric cardia cancer. Thirtyseven cases were diagnosed by 99Tcm-labelled human serum albumin scintigraphy and 24 cases were diagnosed clinically. Treatment was focused on underlying diseases. The clinical manifestations in 21 cases of SLE improved after SLE was controlled. In 2 cases of intestinal lymphangiectasia and one with Crohn's disease, the clinical manifestations improved after surgery. The other patients had no improvement.Conclusions PLE was not uncommon in clinical practice. Its predominant characteristics were severe hypoalbuminemia, edema and dropsy of serous cavity. PLE can complicate other diseases such as SLE,intestinal lymphangiectasia. Treatment should be focused on primary disease.
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Objective To summarize the clinical features, diagnosis and treatment of autoimmune pancreatitis (AIP). Methods From March 2003 to January 2008, a total of 16 cases of AIP were reviewed retrospectively. Results The ratio of male: female was 15:1, with a mean age of 61 years old (range:47-79 years old). Jaundice was the main clinical presentation in 81.2% patients. 68.8% patients presented with high serum gammaglobulin, while 66.7% with high serum IgG, 56.2% with elevated ESR, 50.0% with positive rheumatoid factor(RF), 43.7% with eosinophilia, 26.7% with positive antinuclear antigen(ANA),31.2% with elevated lipase, 18.7% with elevated amylase, and 25.0% with elevated CA19-9. 93.7%patients showed diffuse swelling of the pancreas on CT and/or endoscopic ultrasound. Stricture of the main pancreatic duct was seen in 100% patients. Distal common bile duct stricture was seen in 87.5%, while thickened wall of bile duct was seen in 50%. Histological findings of the pancreas EUS-FNA showed nonspecific results in one patient, while no tumor cell was detected in other 5 patients; lymphocytes infiltration was noted in 3 patients; pancreatic fibrosis was seen in 2 patients. 75.0% patients was found to have diabetes or abnormal sugar tolerance, enlargement of the celiac lymph nodes in 43.7%, splenic vein or inferior cava vein involvement in 42.9%, swelling of the maxillary glands in 18.7%, the lacrimal glands in 12%. Prednisone was given to 11 patients, among them 5 patients underwent endoscopic stent placement, and 10 patients responded well while 1 patient discontinued therapy due to intolerance. 2 patients underwent endoscopic stent placement alone and jaundice disappeared. 3 patients received conventional medical treatment. Steroid therapy exerted different effects on levels of the blood glucose, the enlarged maxillary and lacrimal glands improved after steroid therapy. Conclusions AIP occurred in middle aged and senior male predominantly, painless obstructive jaundice was the main clinical presentation, and patients may be accompanied with elevated levels of IgG, hypergammaglobulin, positive RF and ANA, diffuse or focal pancreatic enlargement, pancreatic duct stricture and distal common bile duct stricture. Stent placement could improve the symptoms, and steroid therapy was effective.