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Objective To analyze the clinical characteristics of type 1 autoimmune pancreatitis (AIP) in patients.Methods The clinical data of 27 patients with type 1 AIP treated at Fujian Provincial Hospital from January 2012 to October 2018 were retrospectively analyzed.Results There are 25 males (92.6％) and 2 females (7.4％) (ratio 12.5∶1).The age of disease onset was (59.5 ± 14.3) years.The most common presenting symptoms were jaundice and abdominal pain (both 59.3％).The most common complication was IgG4-related sclerosing cholangitis (63.0％).Magnetic Resonance Cholangiopancreatograhpy (MRCP) conducted on 26 patients showed the diffuse type 1 AIP was most common (53.8％),only 2 patients (7.7％) presented with a main pancreatic duct stricture.The pancreatic segment of bile duct narrowing was very common (84.6％),and most patients presented as tapered narrowings (65.4％).Standard glucocorticoid therapy was given to these 27 patients who responded well with clinical and laboratory remissions.Two patients were given maintenance glucocorticoid therapy for a high level of serum IgG4.Conclusions Type 1 AIP can present as a local manifestation of IgG4-related disease.The most common complication is IgG4-related sclerosing cholangitis.Glucocorticoid therapy was effective but some patients required maintenance therapy.
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OBJECTIVE:To observe the clinical efficacy and safety of intravitreal injection of ranibizumab combined with argon laser therapy in the treatment of ischemic neovascular glaucoma. METHODS:A total of 166 patients with neovascular glaucoma selected from our hospital during Mar. 2014-Mar. 2016 were divided into control group and observation group according to random number table,with 88 cases in each group(there were 117 and 125 eyes respectively). Both groups received argon laser photocoagulation therapy twice a week for 1 month. Observation group was additionally given intravitreal injection of Ranibizumab injection(0.5 mg)once a week,for 1 month. Clinical efficacies of 2 groups were observed,and the intraocular pressure and visual acuity of 2 groups were observed before treatment,1 week and 1 month after treatment. The occurrence of ADR was recorded. RESULTS:After 1 month of treatment,total response rate was 95.20％ in observation group,which was significantly higher than 76.92％ in control group,with statistical significance (P<0.05). After 1 week of treatment,intraocular pressures of observation group were lower than before treatment and control group at the same time,while visual acuity was better than before treatment and control group at the same time,with statistical significance (P<0.05). After 1 month of treatment,intraocular pressures of 2 groups were decreased significantly and visual acuity was significantly improved;intraocular pressure was decreased and visual acuity was improved more significantly in observation group than control group,with statistical significance(P<0.05 or P<0.01). The incidences of ADR of 2 groups were 3.41％ and 2.27％,without statistical significance (P>0.05). CONCLUSIONS:The ischemic intravitreal injection of ranibizumab combined with argon laser therapy is better than argon laser therapy alone in the treatment of ischemic neovascular glaucoma,and can significantly reduce intraocular pressure and improve visual acuity with good safety.
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Objective To investigate the significance and possible mechanism of food intolerance in diarrhea-predominant irritable bowel syndrome (IBS-D).Methods Twenty-seven IBS-D patients matched the Rome Ⅲ criteria were selected as IBS-D group.Twenty-seven healthy individuals without gastrointestinal symptoms were assigned to control group.Food intolerance situation of two groups were analyzed with food intolerance status evaluation questionnaire,and detection of 14 food specific IgG antibody.The severity of IBS symptoms of IBS-D group were scored by IBS-symptom severity scale (SSS).Two pieces of mucosal tissues of both ileocecal junction and sigmoid colon were obtained under colonoscopy.The content of mucosal substance P (SP) was determined by immunohistochemistry.The quantity of mast cells were detected by Giemsa staining.Chi square test and Fisher exact probability method were performed for rate comparison between two groups.Measurement data were compared with t test and Mann-Whitney rank sum test.The correlation between IBS-SSS score and mast cells and the expression of SP positive cells were analyzed by Spearman rank correlation analysis.Results There was no statistically significant difference in positive rates of food specific IgG between two groups (x2 =3.085,P=0.389),however according to food intolerance status evaluation questionnaire,the incidence of food intolerance of IBS-D group was 44.4 ％ (12/27) which was higher than that of control group (14.8 ％,4/ 27),the difference was statistically (x2 =5.684,P=0.017).Food intolerance severity index of IBS-D group (median:0(0,60)) was higher than that of control group (median:0(0,0)),and the difference was statistically significant (U=239.50,P =0.007).In foods that may cause intolerance,the percentage of foods rich in fermentable oligosaccharides and monosaccharides,disaccharides and polyol (FODMAP) such as milk,noodles,soybeans was up to 71.4％ (30/42).The expression tates of SP positive cells in the mucosa of ileocecal junction and sigmoid colon of patients with IBS-D were higher than those of the control group (x2-20.735 and 22.071,both P＜0.01).The numbers of mast cell in the mucosa of ileocecal junction and sigmoid colonic of patients with IBS D (2.40 ± 1.04/high power field (HPF) and 2.35±1.11/HPF) were more than those of the control group (0.97 ± 0.70/HPF and 0.89 ± 0.72/HPF),and the difference was statistically significant (t=-5.850 and-5.629,both P＜0.01).The severity of bowel symptom of patients with IBS-D was moderately correlated with the number of mast cells in the mucosa of sigmoid colon (r=0.576,P=0.002),and was moderately correlated with the expression of SP positive cells (r=0.691,P＜0.01).Conclusions There may be relation ship among low-grade inflammation of intestinal mucosa,food intolerance and severity of intestinal symptoms in patients with IBS-D.
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Objective To observe the effect of prevention and treatment of gastrointestinal failure and coagu-lation function in severe acute pancreatitis(SAP)with single Rhubarb.Methods 68 caese with SAP were randomly divided into control group(n =34)and treatment group(n =34)by random number table.Both two groups were given routine western medicine,but in the treatment group the patients were additionally administered with single Rhubarb orally or nasal feeding.The time of first defecation,abdominal pain disappeared,bloating disappeared,upper abdomi-nal tenderness disappeared,serum amylase recovery,correction degree of coagulation function and average hospitaliza-tion days of the two groups were compared.Results The time of first defecation in the treatment group was (46.0 ± 18.0)h,which was (73.0 ±23.0)h in the control group,there was significant difference between the two groups(t =2.43,P <0.05).The time of abdominal pain disappeared[(4.3 ±1.2)d],bloating disappeared[(5.2 ±1.6)d], upper abdominal tenderness disappeared[(5.0 ±1.7)d],serum amylase recovery[(6.2 ±1.3)d]of the treatment group were significantly shorter than those of the control group[(5.6 ±1.7)d,(6.7 ±2.3)d,(6.4 ±2.1)d,(8.9 ± 1.6)d](t =2.36,2.17,2.60,2.48,all P <0.05).The average hospitalization days of the treatment group[(24.5 ± 12.3)d]was significantly shorter than the control group[(30.6 ±12.9)d](t =2.65,P <0.05).5 days after treat-ment,in the treatment group,the partially activated thromboplastin time(APTT)[(30.39 ±4.98)s]and prothrombin time(PT)[(12.65 ±1.32)s]were significantly shorter than the control group[(37.25 ±6.27)s,(14.87 ±1.68)s] (t =2.54,2.43,all P <0.05).The platelet count(PLT)and the fibrinogen(FIB)in treatment group were (186.30 ± 59.82)×109 /L and (3.89 ±1.17)g/L repectively,those in control group were (131.80 ±48.57)×109 /L and (5.29 ±1.33)g/L repectively,the differences were statistically significant between the two groups(t =2.16,2.83,all P <0.05).Conclusion The routine western medicine and additionally administered with single Rhubarb can effec-tively prevent and treat gastrointestinal failure,significantly improve coagulation function in SAP.
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Background:Functional dyspepsia(FD)is a commonly seen functional disease which has great impact on patient’s quality of life and mental health,and has got more and more concern by clinicians. Aims:To explore the role of mast cells (MC)and plasma motilin( MTL)in the pathogenesis of FD. Methods:Sixty FD patients including 32 postprandial distress syndrome(PDS)and 28 epigastric pain syndrome(EPS)patients from September 2013 to January 2014 at the Affiliated Hospital of Putian University were enrolled,and 28 healthy volunteers were served as controls(HS group). The number of gastric mucosal MC,plasma MTL level(fasting and 30 minutes after drinking warm water)and gastric emptying time(T1 / 2 )were compared. Results:Compared with HS group,number of gastric mucosal MC was significantly increased (P < 0. 001),plasma MTL level before and after drinking warm water in FD group were significantly decreased( P <0. 001),T1 / 2 was significantly prolonged(P < 0. 001). No significant difference in number of MC was found between PDS subgroup and EPS subgroup(P = 0. 094). Plasma MTL level before and after drinking warm water in PDS subgroup were significantly lower than those in EPS subgroup( P < 0. 001),and T1 / 2 was significantly prolonged( P < 0. 001). Conclusions:Number of gastric mucosal MC is significantly increased in FD patients compared with HS group,suggesting MC may play a role in the pathogenesis of FD. Plasma MTL level is decreased in FD patients,which may be one of the factors involved in the pathogenesis and occurrence of corresponding symptoms of FD.
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Objective To analyze the clinical observation and incidences of complications of therapeutic post-endoscopic retrograde cholangiopancreatography (ERCP).Methods The clinical information of 1 482 cases of therapeutic ERCP was analyzed retrospectively.Results Among them,468 cases had nasal biliary drainage,532 cases had pancreatic or bile duct stent after endoscopic procedure and the other 482 case hadn't.For the drainage group, there were 396 cases of biliary stone,36 cases of simple dilatation of common bile duct,8 cases of biliary cyst,6 cases of strictured papilla,18 cases of inflammatory stricture of common bile duct,2 cases of sclerosing cholangitis and 2 cases of autoimmune pancreatitis.For the pancreatic or bile duct stent group,there were 483 cases of malignant bili-ary obstruction,13 cases of biliary stone,28 cases of pancreatic duct stone,3 cases of sclerosing cholangitis and 5 cases of inflammatory stricture of common bile duct.And there were 385 cases of biliary stone,36 cases of simple dilatation of common bile duct,38 cases of inflammatory stricture of common bile duct,11 cases of strictured papilla, 9 cases of pancreatic duct stone and 3 cases of biliary cyst for un -drainage group.The incidences of acute pancreati-tis and acute cholangitis (4.4%,2.6%)were higher in un -drainage group than the nasal biliary drainage group (1.5%,0.6%,P 0.05)and the stent group(0.4%,0.8%,P >0.05).The incidences of 4 kinds of complications were not significantly different between the nasal biliary drainage group and the stent group.Conclusion Endoscopic nasal biliary drainage or stent can prevent and treat some of therapeutic ERCP com-plications effectively.
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Objective To analyze the clinical features and prognosis of hyperlipidemic acute sancreatitis (HLAP) .Methods A retrospective study was conducted in a cohort of 72 hyperlipidemic acute pancreatitis patients admitted in hospital from June 2007 to June 2012 .83 patients with acute biliary pancreatitis (ABP) diagnosed were served as control group .The clinical data of both groups were compared between the two groups .The correlation between serum triglyceride(TG) levels and disease severity of HLAP was assessed .Results The age and serum amylase levels of the HLAP group were remarkably lower than those of the ABP group (both P0 .05) .The Ranson score ,APACHE-Ⅱ score ,and Bal-thazar CT score were comparable between the two groups (all P>0 .05) .The recurrence risk of HLAP group was strikingly higher than that of ABP group(P0 .05) .The serum TG levels of HLAP showed no significant correlation with Ronson score ,APACHE-Ⅱ score and Balthazar CT score values(all P>0 .05) .Conclusion HLAP mainly occurs in young to middle-aged people .The serum amylase val-ues of HLAP increased mildly .Patients with HLAP are often accompanied by fatty liver and type 2 diabetes ,and subjected to grea-ter complications and recurrence risk .The severity of HLAP doesn′t correlate with the serum TG levels .
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Objective To investigate the clinical characteristics of alcoholic severe acute pancreatitis (SAP). Methods Clinical data of 166 cases of SAP in Fujian Provincial Hospital from January 2001 to December 2008 were collected and analyzed retrospectively. Cases were divided into alcoholic SAP group (43cases) and control group ( 123 cases) depending on deoholic intake volue whithin 12～48 hours. Age, gender,CT scores, APACHE Ⅱ score, serum glucose, serum triglyceride (TG), serum calcium, serum albumin,morbidity, later infection rate and mortality rate of the two groups were compared. Results There was no significant difference in terms of age, but the proportion of male in alcoholic SAP group (39/43) was higher than that in control group (58/123, P<0.01 ). CT score, serum glucose and calcium were not significantly different between the two groups. The APACHEⅡ score and serum TG in alcoholic SAP group [19.16±5.38,(5.06±4.03)mmol/L] were significantly higher than those in control group [16.02±5.09, (3.12±2.95)mmol/L]. The albumenjolevel in alcoholic SAP group (25.23±7.12)g/L) was lower than that in control group [(30.68±8.35 ) g/L, P<0.01]. The incidences of ARDS and upper gastroenterologic bleeding were not significantly different between the two groups. But the incidences of acute kidney failure (44.2%), liver failure (41.9%), heart failure (37.2%), shock (39.5%), infection (27.9%) and mortality (30.2%) in alcoholic SAP were significantly higher than those in control group (26.0%,30.9%, 20.3%, 16.3%,16.3%, 7.3%, P<0.05 or<0.01). Conclusions Males predominates alcoholic SAP patients with high mortality and morbidity. Alcohol abstinence is effective to prevent alcoholic SAP ocurrence.