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Objective To explore the efficacy of standardized diabetes self-management education program. Methods A total of 200 cases of diabetes patients were divided into experimental group and control group with 100 cases each by random digits table method. For experimental group, the patients received standardized diabetes self-management education, for control group, traditional management and occasional telephone follow-up, for 6 months. Blood glucose metabolism, lipid, diabetes self-management ability were evaluated. Results The score in diet control, exercise therapy, medication, self-blood glucose monitoring, complication prevention and self-management ability of experimental group were (20.56 ± 1.23), (15.57 ± 1.62), (13.95 ± 1. 85), (14.62 ± 6.81), (31.65 ± 1.95) , (96.52 ± 1.28) points, and the score of control group were (19.74±1.36), (13.67±3.82), (12.66±1.03), (12.26±2.29), (29.56±1.76), (90.36± 1.94) points. Compliance of two group was improved, and experimental group much better ( t=3.53-5.82, all P<0.05). The fasting blood glucose, postprandial 2h blood glucose, glycosylated hemoglobin, triacylglycerol and total cholesterol of experimental group were (5.52±1.32) mmol/L, (7.69±3.62) mmol/L, (6.22±4.21)%, (1.42±1.28) mmol/Land (4.36±1.27) mmol/L, and those of control group were (6.56±1.23) mmol/L, (8.78±5.42) mmol/L, (7.12±4.29)%, (1.78±1.49) mmol/L and (4.71±2.14) mmol/L. Metabolism of two group was improved, and experimental group much better (t=4.93-6.78, all P<0.05). Conclusions Standardized diabetes self-management education is better than traditional management. It is worthy of clinical application.
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Objective To explore the efficacy of standardized diabetes self-management education program. Methods A total of 200 cases of diabetes patients were divided into experimental group and control group with 100 cases each by random digits table method. For experimental group, the patients received standardized diabetes self-management education, for control group, traditional management and occasional telephone follow-up, for 6 months. Blood glucose metabolism, lipid, diabetes self-management ability were evaluated. Results The score in diet control, exercise therapy, medication, self-blood glucose monitoring, complication prevention and self-management ability of experimental group were (20.56 ± 1.23), (15.57 ± 1.62), (13.95 ± 1. 85), (14.62 ± 6.81), (31.65 ± 1.95) , (96.52 ± 1.28) points, and the score of control group were (19.74±1.36), (13.67±3.82), (12.66±1.03), (12.26±2.29), (29.56±1.76), (90.36± 1.94) points. Compliance of two group was improved, and experimental group much better ( t=3.53-5.82, all P<0.05). The fasting blood glucose, postprandial 2h blood glucose, glycosylated hemoglobin, triacylglycerol and total cholesterol of experimental group were (5.52±1.32) mmol/L, (7.69±3.62) mmol/L, (6.22±4.21)%, (1.42±1.28) mmol/Land (4.36±1.27) mmol/L, and those of control group were (6.56±1.23) mmol/L, (8.78±5.42) mmol/L, (7.12±4.29)%, (1.78±1.49) mmol/L and (4.71±2.14) mmol/L. Metabolism of two group was improved, and experimental group much better (t=4.93-6.78, all P<0.05). Conclusions Standardized diabetes self-management education is better than traditional management. It is worthy of clinical application.
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A patient with severe hypoglycemia due to insulin-like growth factor ( IGF)-IIsecreted by a giant solitary fibrous tumor of the pleura ( SFTP) was investigated through comprehensively reviewing his medical history and clinical records. The patient had severe hypoglycemia accompanied with significantly decreased serum insulin level. A solitary fibrous tumor of the pleura was found, and right pneumonectomy removed this giant tumor. Two years after the operation, the patient was fit and well with no further hypoglycemia episodes. Non-islet-cell tumor hypoglycemia should be considered in patients who have hypoglycemia episodes accompanied with significantly decreased serum insulin level.
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Recent studies have shown that brain natriuretic peptide ( BNP ) may be the link between cardiovascular disease and metabolic system. The role for BNP in metabolic pathways has already been the subject of intense interest. This article reviews the evidence of the linkage between BNP and metabolic system.
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Objective To investigate clinical effect of combined laparoscopic and endoscopic submucosal resection for the gastric antrum-body tumors originated from the muscularis propria.Methods A total of 8 patients with gastric antrum-body tumors originated from the muscularis propria were treated by combined laparoscopic and endoscopic submucosal resection from Jan 2013 to Apr 2014.All patients were diagnosed as having gastric antrum-body tumors originated from the muscularis propria by preoperative endoscopic ultrasonography.Endoscopy showed that the surface mucosa of tumors were normal in all patients.Tumors were found in the gastric antrum-body front wall in 4 cases,and in the back wall in 2 cases,and in the lesser omental bursa in 1 case,and in the greater omental bursa in 1 case.The tumors size was from 1.5 to 3.5 cm,averaging (2.4 ± 0.7) cm.The therapeutic procedure included three phases.The lesion was first exposed with laparoscopy.Then,the fluid was injected into the submucosa in the part of tumor by endoscopy.Finally the tumor was resected by laparoscopy.These patients were followed up and analyzed retrospectively.Results Combined laparoscopic and endoscopic submucosal resection was successfully performed in all patients.All tumors were resected completely.Sever bleeding,infection or death were not found in any patients.Postoperative pathology and immunohistochemistry staining confirmed 6 stromal tumors and 2 neurofibroma.All patients were followed up for 6 months,and there was no recurrent case.Gastric mucosa and function were normal in all patients.Conclusion Combined laparoscopic and endoscopic submucosal resection is a simple,safe and effective method for gastric antrum-body tumors originated from the muscularis propria,and leads to little complication.
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ObjectiveTo retrospectively evaluate the clinical efficacy of endoscopic submucosal tunnel resection for esophageal leiomyoma originating from muscularis propria.MethodsA total of 16 patients with esophageal mass originating from muscularis propria were recruited with informed consents from January 2011 to November 2011,and underwent esophageal submucosal tunneling endoscopic resection.ResultsAll lesions were completely resected.Histological examinations confirmed the diagnosis of leiomyona,and immunohistochemical staining indicated active hyperplasia in 9 cases.Intraoperative mediastinal,subcutaneous and retroperitoneal emphysema occurred in one patient,and the patient recovered one week later.No other complications or death were recorded.The patients were followed up for six months on average,and no cases of recurrence were found.ConclusionEndoscopic submncosal tunnel resection of esophageal leiomyoma originating from the muscularis propria is a minimally invasive,safe and effective procedure.
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Ectopic ACTH syndrome caused by adrenal pheochromocytoma is very rare.A case was herewith reported and the domestic and foreign literatures were reviewed.The correct diagnosis of the syndrome depends on clinical,biochemical,hormonal,radiographic,pathological investigations,as well as tumor immunohistochemistry for final comprehensive judgments.
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Primary pigmented nodular adrenal disease (PPNAD) is a kind of autosomal dominant inherited disease. Patient in the study presented with Cushing's syndrome, and clinical and pathological diagnosis of PPNAD was confirmed. It is now confirmed that there are two relevant genes and their mutations may lead to PPNAD. This study showed no mutations in the patient, surpecting if there would be an alternative mechanism or a new gene in playing the role.
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Objective To summarize and analyze the pathological characteristics of solid pseudopapillary tumor of pancreas (SPTs).Methods The clinical data of 51 cases of SPTs were retrospectively analyzed.The immunohistochemical localizations of different markers (HSE,SYN,CD_(56),CD_(10),Nestin,Vim,a1-ACT,EMA,AE1/AE3 and CK19) on 39 SPTs were studied.Results Pathological features included a combination of solid and cystic components with pseudopapillae formation and degenerative regions without glands.Among the 39 cases of SPTs,the expression rate of NSE was 97.4%,the expression rate of CD_(56),CD_(10) was 84.6%,the expression rate of Nestin and Vim was 64% and 87%,the expression rate of S100 was 79.5%,the expression rate of a1-ACT and a1-AT was 82.1% and 79.5%,while the expression rate of SYN was 12.8%;however there was low expression and weak positive reaction of EMA,AE1/AE3 and CK19.Conclusions The typical pathological characteristics of SPTs may result from gradual degenerative changes induced anoxemia in some SPT's areas.The heterogeneity of SPTs on different antibody markers showed that the SPTs may be originated from pancreatic embryonic stem cells,and result from immature differentiation of the pluripotential stem cells during pancreatic genesis.
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be diagnosed by imaging examination before operation.The ALT patients with large or symptomatic adrenal lipomatous lesions or preoperatively diagnosed teratoma should be given surgical treatment.
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Helicobacter pylori (H. Pylori) infection has been an established risk factor for gastric cancer identified by World Health Organization. H. Pylori triggers chronic inflammation of gastric mucosa and induces host cells to release various cytokines, some of which might lead normal epithelial cells to transfer to gastric cancer. Expression of interleukins in gastric mucosa experiences significant changes after H. Pylori infection. Interleukins play different roles in carcinogenesis and development of gastric cancer. This article briefly reviews the research advances of roles of interleukins in carcinogenesis and development of gastric cancer.
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Objective The aim of this study was to describe the FICE application on gastric mucosa characteristics including normal and pathological changes, with or without H.pylori infection, and its corre-lation with histopathoingical evidence. Methods A total of 32 patients with dyspepsia symptoms and 5 healthy controls were enrolled into study. Each one underwent esophngogastreduedenoscopy (EGD) examina-tion with FICE and magnified observation. The whole stomach was examined by 3 steps: including conven-tional endoscopy followed by magnifying and FICE observation of the gastric antrum and body as well as biop-sies. All the patients were asked to take the rapid urease test (RUT) 、13C -urea breath test (13C-UBT) . Gastric antrum and body were both sub-classified into following 3 patterns by FICE observation and high reso-lution magnifying endoscopy. The sensitivity, specificity of each FICE pattern of both gastric antrum and body were analysed for the assessment of H. pylori infection, and the consistency with the results of RUT and 13C-UBT. Furthermore, the histopathologic parameters including inflammation、activity、atrophy and intestinal metaplasia were also assessed, Results FICE patterns of gastric antrum and body of all 5 control subjects were type Ⅰ, corresponded to an H. pylori negative and non-atrephy gastric mueosa. In study group on gastric antrum, 14 cases of FICE type Ⅰ pattern were noted and only 1/14(7. 1%) corresponded to an H. pylori positive gastric mucosa. 13 cases of FICE type Ⅱ pattern were noted and 10/13 (76. 9%) corresponded to an H.pylori positive mucosa and 9/13(69. 2%) were positive for both gastric atrophy. 5 cases of FICE type Ⅲ pattern were noted and 5/5 (100%) corresponded to an H. pylori positive mucosa and 3/5 (60%) were positive for both gastric atrophy and intestinal metaplasia. There was statistical difference in prediction of H. pylori infection between type Ⅰ FICE pattern and type Ⅱ or type Ⅲ pattern on gastric antrum (P <0. 01). In study group on gastric body, 15 cases of FICE type Ⅰ pattern were noted and only 1/14(7. 1%) corre-sponded to an H. pylori positive gastric mucosa. 13 cases of FICE type Ⅱ pattern were noted and 11/13 (84. 6%) corresponded to an H. pylori positive mucosa. 4 cases of FICE type Ⅲ pattern were noted and 4/4 (100%) corresponded to an H.pylori positive mucosa. There was statistical difference in prediction of H. pylori infection between type Ⅰ FICE pattern and type Ⅱ or type Ⅲ pattern on gastric body (P < 0. 01). Conclusion FICE in combination with high resolution magnifying endoscopy is valuable for identifying the normal gastric mucosa, H.pylori infection and its associated gastritis, gastric atrophy as well as intestinal metaplasia.
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Objective To evaluate the accuracy and clinical application of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in diagnosis of occupying lesions in upper digestive tract and its pe-ripheral areas. Methods The data of 64 patients who underwent EUS-FNA for occupying lesions in upper di-gestive tract, between July 2006 and December 2007, were retrospectively analyzed. Results EUS-FNA was successfully performed on 62 patients, with a success rate of 96.88%. The overall diagnostic accuracy, sensi-tivity, specificity, positive predictive value and negative predictive value of EUS-FNA for occupying lesions in upper digestive tract and its peripheral areas were 88.71%, 86.54%, 100.00%, 100.00%, and 58.82%, respectively. There was no significant difference between the foei larger and smaller than 3cm (P > 0.05), re-garding the diagnostic accuracy and average puncture numbers. Diagnostic accuracy of those with real-time cy-tolngical evaluation was significantly higher than those without (P=0.029), and the puncture numbers were less (P=0.001). Among the total 99 punctures, the positive diagnostic accuracy of those with 5ml negative pressure suction was significantly higher than those of 10 ml (P = 0.044). Conclusion EUS-FNA is a safe and applicable approach to diagnosis of occupying lesions in upper digestive tract and its peripheral areas with higher diagnostic accuracy, sensitivity, specificity and positive predictive value. Moreover, the real-time cyto-logical evaluation and adequate negative pressure might facilitate the diagnosis accuracy.
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Objective To explore the experience on using duodenoscope to treat hepatolithiasis through normal physiological ways.Methods ERCP,EST were used firstly,then removed calculus of the extrahepatic bile duct.Endoscopic papillary balloon dilatation was used if there was stenosis of bile duct.Removed calculus when it had been crushed in the hepatic duct.Injected decoction to dissolve calculus through endoscopic nasobiliary drainage,or inserted the endoscopic retrograde biliary drainage when the calculus was hard to removded.Results 101 cases of calculus in the extrahepatic bile duct were all removed.215 cases of hepatolithiasis were cleaned out at first time.9 cases were cured 1 week after dissolving calculus through endoscopic nasobiliary drainage.59 cases carried out ERBD,and 21 of them were cured 3 months later,37 patients were still in regular follow-up.33 cases with stenosis of bile duct were treated by endoscopic papillary balloon dilatation,19 of them were cured,the others were inserted with the endoscopic retrograde biliary drainage.19 cases of cholangitic abscess were cured by endoscopic nasobiliary drainage.Conclusion Using duodenoscope to treat hepatolithiasis through normal physiological ways is safe and effectic.
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Objective To evaluate the diagnosis and surgical treatment of parathyroid carcinoma (PTC). Methods Clinical data of 8 PTC cases were analyzed retrospectively. Results PTC accounted for 5. 7% of patients with primary hyperparathyroidism (PHPT) in our hospital. There were 4 men and 4 women. Male patients had younger mean onset age compared with female patients. The disease history of PTC was shorter than PHPT of benign causes. Six patients were admitted for acute hypercalcemia. Seven patients complained of palpable neck mass. Calcium level was 3.75?0.34 mmol/L,and PTH level was 1429.47?841.75 pg/ml. Frozen section established diagnosis in only one case. Four patients underwent radical en bloc resection. Other 4 cases received routine simple parathyroidectomy, 3 patients developed recurrence in 12 - 18 months postoperatively. Conclusions Acute hypercalcemia is common in PTC. Frozen biopsy diagnosis is not satisfactory. An initial en bloc resection of tumor and adjacent structures contributes most to the prognosis.
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Objective To explore the experience of the double guide wires technology in the difficult ERCP examinations.Methods There were 776 difficult ERCP patients.701 cases with difficult cannulation of the bile duct had been inserted another guide wire into the upper left corner of the duodenal papilla after retained pancreatic guide wire.75 cases with difficult cannulation of the pancreatic duct had been inserted another guide wire into the right vertical direction of the duodenal papilla after retained a guide wire into the commom bile.Results 697cases(99.4%)with difficult cannulation of the bile duct were examined successfully at first time;74 cases(98.7%)with difficult cannulation of the pancreatic duct were examined successfully at first time.Conclusion Double guide wires technology is easy to use.The method of retaining a guide wire into the duct which was cannulated easily may increases the achievement ratio of cannulation into another duct.The check time was shortened significantly.
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High expressions of IGF Ⅱ mRNA and protein were demonstrated by RT PCR and IRMA analysis in tumor tissue of a patient with non islet cell tumor induced hypoglycaemia (NICTH). Northern blotting results displayed abundant 6.0, 5.3, 5.0, 4.8 kb IGF Ⅱ transcripts in the tumor. It suggests that autosecretive production of IGF Ⅱ of the tumor plays an important role in the pathogenesis of tumor induced hypoglycemia.
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Objective To increase the awareness of ectopic ACTH syndrome in patients with thymus carcinoid. Methods Clinical manifestations, especially atypical presentation of ectopic ACTH syndrome, laboratory findings and imaging data (chest X-ray and CT, etc.) in 6 patients were analysed. Results In all 6 patients, the thymus tumors removed were pathologically proved to be thymus carcinoid. Conclusion Patients having typical manifestations of Cushing′s syndrome with hypokalemia, edema, proteinuria and equivocal result of dexamethasone inhibition test, should be considered as ACTH syndrome. And thymus carcinoid seems to be the cause of the disease.
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Objective To improve the diagnosis and management of solid-pseudopapillary tumor (SPT) of the pancreas. MethodsTwenty-two SPT patients were retrospectively reviewed and divided into two groups, misdiagnosed group and those with preoperatively correct diagnosis. ResultsAbout one half (46%) SPT cases were misdiagnosed preoperatively. With time SPT tends to invade its capsule resulting in impossibility of radical resection, and increased medical expenses. ConclusionsAlthough SPT is of low degree malignant, and the prognosis after surgical resection is satisfactory, misdiagnosis and preoperative misdiagnosis and inappropriate management still cost the patients increased expenses and inhospital stay.
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Specimens from 12 cases of pancreatic endocrine tumors were investigated by light and electron microscopy and immunohistochemical staining. Pancreatic stem cell-like cells with special characteristics of pancreatic stem cell were found in the proliferating small ductules and dispersed at the margins of pancreatic endocrine tumors in all the cases studied.