A 35-year-old woman with a history of regular menstruation presented with a positive urine pregnancy test and elevated blood human chorionic gonadotropin concentrations.Color Doppler ultrasound showed multiple slightl...A 35-year-old woman with a history of regular menstruation presented with a positive urine pregnancy test and elevated blood human chorionic gonadotropin concentrations.Color Doppler ultrasound showed multiple slightly hyperechoic areas within the uterine cavity.She was admitted to the hospital with a preliminary outpatient diagnosis of“suspected molar pregnancy,pending further evaluation.”展开更多
Heterotopic mesenteric ossification(HMO)is a rare medical condition,with<100 cases reported globally by 2024.This disorder is characterized by abnormal bone tissue formation within the mesentery,often following abd...Heterotopic mesenteric ossification(HMO)is a rare medical condition,with<100 cases reported globally by 2024.This disorder is characterized by abnormal bone tissue formation within the mesentery,often following abdominal trauma,ischemia,or infection.This editorial reviews the case presented by Zhang et al,involving a 34-year-old male who developed persistent left lower abdominal pain after sustaining blunt trauma to the abdomen.Diagnostic challenges arose due to the rarity and nonspecific presentation of HMO,which shares histopathological features with conditions such as myositis ossificans and necessitates differentiation from malignancies like sarcomas.Advanced imaging revealed calcifications suggestive of HMO,but definitive diagnosis was achieved only through surgical resection and histopathological analysis,which confirmed the presence of ectopic bone formation.Although benign,HMO can result in severe complications,such as bowel perforation or obstruction.Therefore,awareness of HMO is crucial for clinicians to ensure timely and appropriate treatment.展开更多
BACKGROUND Congenital junctional ectopic tachycardia(CJET)is a rare but life-threatening arrhythmia in neonates and infants,often refractory to conventional antiar-rhythmic therapy.Ivabradine,a selective inhibitor of ...BACKGROUND Congenital junctional ectopic tachycardia(CJET)is a rare but life-threatening arrhythmia in neonates and infants,often refractory to conventional antiar-rhythmic therapy.Ivabradine,a selective inhibitor of hyperpolarization-activated cyclic nucleotide-gated channels,has emerged as a promising drug for CJET management.AIM To evaluate the efficacy and safety of ivabradine in the management of CJET.Specifically,this study aims to analyze the dosing strategies,treatment outcomes,and the role of ivabradine as monotherapy or adjunct therapy in patients who have previously received other antiarrhythmic medications.Additionally,this review seeks to assess the impact of ivabradine on heart rate(HR)control,rhythm conversion,and its overall safety profile to provide evidence-based insights into its clinical use for CJET management.METHODS This systematic review aims to evaluate the outcomes of ivabradine,either as monotherapy or as an adjunctive therapy,in the treatment of CJET.A compre-hensive literature search was conducted across multiple electronic databases to identify relevant studies investigating the use of ivabradine in CJET.Stringent inclusion and exclusion criteria were applied to ensure the inclusion of high-quality,peer-reviewed studies.Data extraction and quality assessment were performed independently by two reviewers.RESULTS Ten studies,comprising 6 case reports,3 case series,and 1 cohort study,met the inclusion criteria.Ivabradine doses ranged from 0.025 to 0.28 mg/kg/dose,administered either as monotherapy or in combination with various antiar-rhythmic medications.Overall,ivabradine demonstrated promising results in achieving HR control,conversion to sinus rhythm,or stabilization of junctional rhythm.No significant adverse effects related to ivabradine were reported.CONCLUSION The available evidence suggests that ivabradine may be an effective adjunctive therapy or,in some cases,a potential monotherapy for the management of CJET,particularly in cases refractory to traditional antiarrhythmic medications.However,the current evidence is limited by the small sample sizes and retrospective nature of the included studies.Well-designed prospective studies with larger cohorts and longer follow-up periods are warranted to further elucidate the role of ivabradine in CJET management.展开更多
Congenital gastric ectopic pylorus(CGEP),also known as gastric ectopic pyloric opening,is a rare congenital gastric abnormality.It was first reported and termed by Yu and Zhao from China in 1983,and in 2007,Uraz et al...Congenital gastric ectopic pylorus(CGEP),also known as gastric ectopic pyloric opening,is a rare congenital gastric abnormality.It was first reported and termed by Yu and Zhao from China in 1983,and in 2007,Uraz et al published the first report of CGEP in the English literature.We conducted a systemic review of the literature of CGEP published in English or Chinese,and found that CGEP occurred more frequently in the 6th and 7th decade of life,with a male predominance(89.7%).The majority of reported cases(89.2%)were from East Asia,and the underlying mechanism remains unknown.Most patients with CGEP presented non-specific symptoms,including abdominal pain,bloating,regurgitation,and belching.A few patients(30%)experienced upper gastrointestinal bleeding.Given the non-specific symptoms,misdiagnosis or underdiagnosis often occurs.Gastroscopy and upper gastrointestinal radiography are the main examinations used to confirm the diagnosis.Currently,conservative medication is the mainstay treatment.In this systematic review,we describe the history,etiology,diagnosis and treatment of CGEP in detail,aiming to provide a comprehensive understanding of this rare disease and avoid misdiagnosis.展开更多
BACKGROUND Bleeding ectopic varices located in the small bowel(BEV-SB)caused by portal hypertension(PH)are rare and life-threatening clinical scenarios.The current management of BEV-SB is unsatisfactory.This retrospec...BACKGROUND Bleeding ectopic varices located in the small bowel(BEV-SB)caused by portal hypertension(PH)are rare and life-threatening clinical scenarios.The current management of BEV-SB is unsatisfactory.This retrospective study analyzed four cases of BEV-SB caused by PH and detailed the management of these cases using enteroscopic injection sclerotherapy(EIS)and subsequent interventional radiology(IR).AIM To analyze the management of BEV-SB caused by PH and develop a treatment algorithm.METHODS This was a single tertiary care center before-after study,including four patients diagnosed with BEV-SB secondary to PH between January 2019 and December 2023 in the Air Force Medical Center.A retrospective review of the medical records was conducted.The management of these four patients involved the utilization of EIS followed by IR.The management duration of BEV-SB in each patient can be retrospectively divided into three phases based on these two approaches:Phase 1,from the initial occurrence of BEV-SB to the initial EIS;phase 2,from the initial EIS to the initial IR treatment;and phase 3,from the initial IR to December 2023.Descriptive statistics were performed to clarify the blood transfusions in each phase.RESULTS Four out of 519 patients diagnosed with PH were identified as having BEV-SB.The management duration of each phase was 20 person-months,42 personmonths,and 77 person-months,respectively.The four patients received a total of eight and five person-times of EIS and IR treatment,respectively.All patients exhibited recurrent gastrointestinal bleeding following the first EIS,while no further instances of gastrointestinal bleeding were observed after IR treatment.The transfusions administered during each phase were 34,31,and 3.5 units of red blood cells,and 13 units,14 units,and 1 unit of plasma,respectively.CONCLUSION EIS may be effective in achieving hemostasis for BEV-SB,but rebleeding is common,and IR aiming to reduce portal pressure gradient may lower the rebleeding rate.展开更多
BACKGROUND This case report presents an innovative approach to managing a complex class II division 1 malocclusion with ectopic maxillary canines using a modified twin block(TB)appliance.The modification facilitated s...BACKGROUND This case report presents an innovative approach to managing a complex class II division 1 malocclusion with ectopic maxillary canines using a modified twin block(TB)appliance.The modification facilitated simultaneous skeletal correction and canine eruption,reducing treatment time and improving patient satisfaction.CASE SUMMARY A 14-year-old male presented with concerns about a retruded chin and spacing between teeth.Clinical and radiographic evaluation revealed a class II division 1 malocclusion on a moderate class II skeletal base,with palatally impacted maxillary canines.Treatment involved a modified Clark TB appliance designed with hooks to allow active traction of the canines,followed by comprehensive fixed orthodontics.Over 18 months,the patient achieved improved occlusion,corrected overjet and overbite,successful eruption of the impacted canines,and enhanced facial aesthetics.The final results showed significant dental and skeletal improvement without requiring surgical intervention.CONCLUSION A modified TB appliance can effectively manage class II malocclusion with impacted canines in growing patients.The modified approach combining functional mandibular advancement and active canine traction represents a lessdocumented clinical adaptation,offering a valuable,efficient alternative to traditional two-phase interventions.展开更多
Inflatable penile prosthesis(IPP)implantation is the gold standard treatment for patients with erectile dysfunction who are refractory to medical therapy.The standard placement of the reservoir in the space of Retzius...Inflatable penile prosthesis(IPP)implantation is the gold standard treatment for patients with erectile dysfunction who are refractory to medical therapy.The standard placement of the reservoir in the space of Retzius(SOR)may be contraindicated in patients with prior pelvic or abdominal surgery due to altered anatomy and increased risk of complications.This has led to the development of alternative ectopic reservoir placement techniques.In this narrative review,we summarize the literature on various ectopic reservoir approaches,including low and high submuscular placements,submuscular techniques with counter incisions or transfascial fixation,midline submuscular placement,subcutaneous placement,and lateral retroperitoneal approaches.We describe the surgical methods,outcomes,and complication rates associated with each technique.While most methods demonstrate low complication and revision rates,direct comparisons remain limited due to heterogeneity and lack of prospective data.This review highlights the importance of individualized technique selection based on prior surgical history,body habitus,and surgeon experience.As ectopic placement becomes more widely adopted,familiarity with multiple approaches is essential for prosthetic surgeons.展开更多
Cervical pregnancy is a rare clinical entity that accounts for less than 1% of all ectopic pregnancies. It results from implantation of the blastocyst in the cervical canal below the level of the internal os. Although...Cervical pregnancy is a rare clinical entity that accounts for less than 1% of all ectopic pregnancies. It results from implantation of the blastocyst in the cervical canal below the level of the internal os. Although non-tubal ectopic pregnancies account for only 5%<span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>of ectopics, they contribute to a significant morbidity. The cornerstone in the management of cervical ectopic is early diagnosis by high index of suspension and a qualified sonographer. Management options for cervical ectopic pregnancies range from conservative drug treatment to radical hysterectomy. Over the last few years, the mortality and morbidity rates of ectopic pregnancies have been reduced. This is mainly due to the early recognition of the condition and the wide availability of minimally invasive surgical procedures. We present a case of a 33-year-old</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>woman that was 16 weeks pregnant. She presented initially with recurrent vaginal bleeding followed by minimal lower abdominal pain. Her early US scans were</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>misleading. Several weeks later,</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>a follow up MRI scan suggested cervical ectopic. She was managed surgically with uterine preservation.</span></span></span>展开更多
A 56-year-old man was found to have a pancreatic tail tumor. His blood chemistry showed no infection with hepatitis B or C virus and no elevations of tumor markers or pancreatic hormones. Abdominal ultrasound showed a...A 56-year-old man was found to have a pancreatic tail tumor. His blood chemistry showed no infection with hepatitis B or C virus and no elevations of tumor markers or pancreatic hormones. Abdominal ultrasound showed an encapsulated, rather heterogeneous, hypoechoic tumor, 6.5 cm in maximum diameter, with a beak sign. Helical dynamic CT revealed an irregularly enhanced tumor with pooling of contrast medium in the delayed phase. Abdominal angiography showed a hypervascular tumor. With a tentative diagnosis of non-functional islet-cell tumor, the patient underwent resection of the pancreatic body and tail with splenectomy. The contour of the liver and its surface were normal. In microscopic examination, tumor cells arranged in a trabecular pattern with focal bile pigment resembling hepatocellular carcinoma (HCC). Immunohistochemically, these tumor cells were positivefor HEPPAR-1, CAM5.2, cytokeratin 18 and COX-2, but negative for MUC-1, and cytokeratins 7, 20 and 8. These results supported a diagnosis of HCC without any adenocarcinoma component. The patient is currently doing well without any signs of recurrence in either the remaining pancreas or liver three years after surgery. We report the rare case with ectopic HCC in the pancreas with a review of the literature.展开更多
Pregnancies in the same side tube after the same side ovary ovulation are more common. We report an unusual case of contralateral tubal ectopic pregnancy after ovulation of another side ovary in spontaneous cycles. A ...Pregnancies in the same side tube after the same side ovary ovulation are more common. We report an unusual case of contralateral tubal ectopic pregnancy after ovulation of another side ovary in spontaneous cycles. A 32-year-old woman underwent laparoscopic left fallopian tube conservative surgery because of left tubal pregnancy two years ago. She returned to our hospital with a positive pregnancy test and lower abdominal pain 28 d after the dominant follicle discharged in the right side ovary detected by transvaginal ultrasound in spontaneous cycles. Transvaginal ultrasonography revealed no intrauterine gestational sac but a left adnexal mass measuring 2.6 cm X2.5 cm. Videolaparoscopy was performed, and the diagnosis of an ectopic pregnancy in the let fallopian tube was confirmed by pathologic report. Tubal damage is the most important risk factor for tubal ectopic pregnancy. Embryos can be reversely migrated toward fallopian tubes, due to retrograde action of endometrial waves and uterine contractions, that is another necessary reason which contributes to such tubal pregnancy. Total salpingectomy or tubal sterilization is necessary for avoiding repeated tubal ectopic pregnancy.展开更多
BACKGROUND The ampulla of Vater is an opening at the confluence of the common bile duct and pancreatic duct.It is located in the second portion of the duodenum.An ectopic papilla of Vater is an anomalous termination.F...BACKGROUND The ampulla of Vater is an opening at the confluence of the common bile duct and pancreatic duct.It is located in the second portion of the duodenum.An ectopic papilla of Vater is an anomalous termination.Few cases have been reported.We report the rare case of a man with an ectopic ampulla of Vater in the pylorus.CASE SUMMARY An 82-year-old man had experienced abdominal pain and fever with chills 1 d before his presentation.A computed tomography scan of the abdomen demonstrated dilatation of the common bile duct approximately 2.2 cm in width.Gas retention was found in his intrahepatic ducts.Acute cholangitis with pneumobilia was identified,and he was hospitalized.Esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography disclosed no ampulla of Vater in the second portion of the duodenum.Moreover,a capsule-like foreign body(pharmaceutical desiccant)approximately 1 cm×2 cm in size was found at the gastric antrum and peri-pyloric region.After the foreign body was removed,one orifice presented over the pyloric ring in the stomach,a suspected ectopic ampulla of Vater.Subsequently,sludge in the common bile duct was cleaned,and balloon dilatation was performed.The general condition improved daily.The patient was discharged in a stable condition and followed in our outpatient department.CONCLUSION This case involved an ampulla of Vater in an unusual location.Endoscopic retrograde cholangiopancreatography with balloon dilatation is the main treatment recommended and performed.展开更多
AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endos...AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endoscopic ultrasonography before endoscopic resection.Endo-scopic resection was performed by two methods:endo-scopic mucosal resection(EMR)by the injection-and-cut technique or endoscopic mucosal dissection(ESD).RESULTS:We planned to perform EMR in all eight cases but EMR was successful in only four cases.In the other four cases,saline spread into surrounding normal tissues and the lesions becameattened,which made it impossible to remove them by EMR.Inthose four cases,we performed ESD and removed the lesions without any complications.CONCLUSION:If conventional EMR is difficult to remove gastric ectopic pancreas,ESD is a feasible alternative method for successful removal.展开更多
This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy（EP） and heterotopic pregnancy（HP） after in vitro fertilization and embryo transfer（IVF-ET） in an attempt to reduce the dia...This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy（EP） and heterotopic pregnancy（HP） after in vitro fertilization and embryo transfer（IVF-ET） in an attempt to reduce the diagnostic error. Clinical data of patients who underwent IVF-ET treatment and had clinical pregnancy from 12463 cycles were retrospectively analyzed. Their findings of serum β-hCG test and transvaginal ultrasonography were also obtained during follow-up. These patients were divided into two groups according to the diagnosis accuracy of EP/HP： early diagnosis and misdiagnosis/delayed diagnosis. The results showed that the incidence of EP and HP was 3.8%（125/3286） and 0.8%（27/3286） respectively for IVF/ICSI-ET cycle, and 3.8%（55/1431） and 0.7%（10/1431） respectively for frozen-thawed embryo transfer（FET） cycle. Ruptured EP occurred in 28 patients due to initial misdiagnosis or delayed diagnosis. Related factors fell in 3 categories：（1） clinician factors： misunderstanding of patients＇ medical history, insufficient training in ultrasonography and unawareness of EP and HP;（2） patient factors： noncompliance with medical orders and lack of communication with clinicians;（3） complicated conditions of EP： atypical symptoms, delayed elevation of serum β-hCG level, early rupture of cornual EP, asymptomatic in early gestation and pregnancy of unknown location. All the factors were interwoven, contributing to the occurrence of EP and HP. It was concluded that complicated conditions are more likely to affect the diagnosis accuracy of EP/HP after IVF-ET. Transvaginal ultrasonography should be performed at 5 weeks of gestation. Intensive follow-up including repeated ultrasonography and serial serum β-hCG tests should be performed in patients with a suspicious diagnosis at admission.展开更多
AIM:To study the clinical,endoscopic,sonographic,and cytologic features of ectopic pancreas(EP).METHODS:This was a retrospective study performedat an academic referral center including two hospitals.Institutional revi...AIM:To study the clinical,endoscopic,sonographic,and cytologic features of ectopic pancreas(EP).METHODS:This was a retrospective study performedat an academic referral center including two hospitals.Institutional review board approval was obtained.Patients referred to the University Hospital or Denver Health Medical Center Gastrointestinal Endoscopy Lab for gastroduodenal subepithelial lesions(SEL)with a final diagnosis of EP between January 2009and December 2013 were identified.Patients in this group were selected for the study if they underwent endoscopic ultrasound(EUS)with fine-needle aspiration(FNA)or deep biopsy.A review of the medical record was performed specifically to review the following information:presenting symptoms,endoscopic and EUS findings,computed tomography or magnetic resonance imaging findings,pathology results,procedure-related adverse events,and subsequent treatments after EUSFNA.EUS with FNA or deep submucosal biopsy was performed in all patients on an outpatient basais by one of two physicians(Attwell A,Fukami N).Review of all subsequent clinic notes and operative reports was performed in order to determine follow-up and final diagnoses.RESULTS:Between July 2009 and December 2013,10patients[3 males,7 females,median age 52(26-64)years]underwent EUS for a gastroduodenal SEL and were diagnosed with EP.One patient was symptomatic.Six(60%)lesions were in the antrum,3(30%)in the body,and 1(10%)in the duodenum.A mucosal dimple was noted in 6(60%).Mean lesion size was 17(8-25)mm.Gastrointestinal wall involvement:muscularis mucosae,10%;submucosa,70%;muscularis propria,60%;and serosa,10%.Nine(90%)lesions were hypoechoic and 5(50%)were homogenous.A duct was seen in 5(50%).FNA was attempted in 9(90%)and successful in 8(80%)patients after 4(2-6)passes.Cytology showed acini or ducts in 7 of 8(88%).Superficial biopsies in 7 patients(70%)showed normal gastric mucosa.Deep endoscopic biopsies were taken in 2 patients and diagnostic in one.One patient(10%)developed pancreatitis after EUS-FNA.Two patients(20%)underwent surgery to relieve symptoms or confirm the diagnosis.The main limitation of the study was the fact that it was retrospective and performed at a single medical center.CONCLUSION:EUS features of EP include antral location,mucosal dimple,location in layers 3-4,and lesional duct,and FNA or biopsy is accurate and effective.展开更多
Insulin resistance is the pathophysiological basis of many diseases.Overcoming early insulin resistance highly significant in prevention diabetes,non-alcoholic fatty liver,and atherosclerosis.The present study aimed a...Insulin resistance is the pathophysiological basis of many diseases.Overcoming early insulin resistance highly significant in prevention diabetes,non-alcoholic fatty liver,and atherosclerosis.The present study aimed at evaluating the therapeutic effects of baicalin on insulin resistance and skeletal muscle ectopic fat storage in high fat diet-induced mice,and exploring the potential molecular mechanisms.Insulin resistance in mice was induced with a high fat diet for 16 weeks.Animals were then treated with three different doses of baicalin(100,200,and 400 mg·kg^(-1)·d^(-1)for 14 weeks.Fasting blood glucose,fasting serum insulin,glucose tolerance test(GTT),insulin tolerance test(ITT),and skeletal muscle lipid deposition were measured.Additionally,the AMP-activated protein kinase/acetyl-CoA carboxylase and protein kinase B/Glycogen synthase kinase 3 beta pathways in skeletal muscle were further evaluated.Baicalin significantly reduced the levels of fasting blood glucose and fasting serum insulin and attenuated high fat diet induced glucose tolerance and insulin tolerance.Moreover,insulin resistance was significantly reversed.Pathological analysis revealed baicalin dose-dependently decreased the degree of the ectopic fat storage in skeletal muscle.The properties of baicalin were mediated,at least in part,by inhibition of the AMPK/ACC pathway,a key regulator of de novo lipogenesis and activation of the Akt/GSK-3β pathway,a key regulator of Glycogen synthesis.These data suggest that baicalin,at dose up to 400 mg·kg^(-1)·d^(-1),is safe and able to attenuate insulin resistance and skeletal muscle ectopic fat storage,through modulating the skeletal muscle AMPK/ACC pathway and Akt/GSK-3β pathway.展开更多
AIM:To evaluate the efficacy of human thrombin in the treatment of bleeding gastric and ectopic varices.METHODS:Retrospective observational study in a Tertiary Referral Centre.Between January 1999-October 2005,we iden...AIM:To evaluate the efficacy of human thrombin in the treatment of bleeding gastric and ectopic varices.METHODS:Retrospective observational study in a Tertiary Referral Centre.Between January 1999-October 2005,we identified 37 patients who were endoscopically treated with human thrombin injection therapy for bleeding gastric and ectopic varices.Patient details including age,gender and aetiology of liver disease/segmental portal hypertension were documented.The thrombin was obtained from the Scottish National Blood Transfusion Service and prepared to give a solution of 250 IU/mL which was injected via a standard injection needle.All patient case notes were reviewed and the total dose of thrombin given along with the number of endoscopy sessions was recorded.Initial haemostasis rates,rebleeding rates and mortality were catalogued along with the incidence of any immediate complications which could be attributable to the thrombin therapy.The duration of follow up was also listed.The study was conducted according to the United Kingdom research ethics guidelines.RESULTS:Thirty-seven patients were included.33 patients(89%) had thrombin(250 U/mL) for gastric varices,2(5.4%) for duodenal varices,1 for rectal varices and 1 for gastric and rectal varices.(1) Gastric varices,an average of 15.2 mL of thrombin was used per patient.Re-bleeding occurred in 4 patients(10.8%),managed in 2 by a transjugular intrahepatic portosystemic shunt(TIPSS)(one unsuccessfully who died) and in other 2 by a distal splenorenal shunt;(2) Duodenal varices(or type 2 isolated gastric varices),an average of 12.5 mL was used per patient over 2-3 endoscopy sessions.Re-bleeding occurred in one patient,which was treated by TIPSS;and(3) Rectal varices,an average of 18.3 mL was used per patient over 3 endoscopy sessions.No re-bleeding occurred in this group.CONCLUSION:Human thrombin is a safe,easy to use and effective therapeutic option to control haemorrhage from gastric and ectopic varices.展开更多
Ectopic varices are unusual with portal hypertension and can involve any site along the digestive tract outside the gastroesophageal region. Hemorrhage from ectopic varices generally are massive and life threatening.D...Ectopic varices are unusual with portal hypertension and can involve any site along the digestive tract outside the gastroesophageal region. Hemorrhage from ectopic varices generally are massive and life threatening.Diagnosis of ectopic varices is difficult and subsequent treatment is also difficult; the optimal treatment has not been established. Recently, interventional radiology and endoscopic treatments have been carried out successfully for hemorrhage from ectopic varices.展开更多
BACKGROUND Ectopic pregnancy(EP) is one of the most common acute abdominal diseases in gynecology. Once the condition of EP is delayed, it may lead to massive hemorrhage, shock, and even death in a short time, serious...BACKGROUND Ectopic pregnancy(EP) is one of the most common acute abdominal diseases in gynecology. Once the condition of EP is delayed, it may lead to massive hemorrhage, shock, and even death in a short time, seriously threatening the patient’s life. Early diagnosis is the key to preventing and improving the prognosis of EP.Transabdominal ultrasound(TAS) and transvaginal ultrasound(TVS) are the main diagnostic methods for abdominal diseases. The purpose of this study is to explore the application value and effect of TAS and TVS in the diagnosis of EP,hoping to provide more valuable references for the diagnosis of EP.AIM To explore the application value of TAS and TVS in the diagnosis of EP and to improve the level of clinical diagnosis.METHODS A total of 140 patients with EP admitted to our hospital from July 2018 to July 2020 were selected for this study. All patients were divided into two groups according to the examination methods. 63 patients who underwent abdominal ultrasound examination were set as the TAS group, while 77 patients who underwent TVS examination were set as the TVS group. We compared the diagnostic accuracy and misdiagnosis rates between the two types of ultrasound examinations, as well as the postoperative pathological results of the two diagnostic methods for different types of ectopic pregnancies. We also analyzed the sonograms for the presence of mixed ectopic masses,adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the ectopic sac shadow, and the detection of fluid in the rectal fossa of the uterus, such as the adnexal area, yolk sac, and embryo, etc. In addition, the diagnosis time, days of gestational sac appearance, operation time, endometrial thickness, and blood flow resistance index were compared as well.RESULTS After performing both types of ultrasound examinations in 140 patients with EP, we found that the diagnostic accuracy of TVS was significantly higher than that of TAS, and the misdiagnosis rate was significantly lower than that of TAS. The differences were statistically significant(P < 0.05). In addition, the detection rate of TVS was better than that of TAS for the presence of mixed masses,adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the shadow of the ectopic sac, and sonograms such as the adnexal area, yolk sac, and embryo,etc. The coincidence rate of its postoperative pathological examination results was significantly higher than those of TAS. The diagnosis time and the days of gestational sac appearance by TVS were significantly shorter than that by TAS, and the operation time was earlier than that by TAS.What’s more, the detection rates of the endometrial thickness ￡ 1.5 mm and blood flow resistance ￡0.5 were significantly higher in TVS diagnosis of EP than in TAS. All differences were statistically significant(P < 0.05).CONCLUSION Compared with TAS, TVS has the advantages of high detection accuracy and good sonogram performance.展开更多
Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male wa...Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain,followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultraso-nography (EUS),which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and surgery.As far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain,choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed.展开更多
Ectopic adrenal cortical neoplasms are extremely rare. Ectopic adrenocortical tissue can be found in locations such as the celiac axis,the broad ligament,the adnexa of the testes,and the spermatic cord;however,they ra...Ectopic adrenal cortical neoplasms are extremely rare. Ectopic adrenocortical tissue can be found in locations such as the celiac axis,the broad ligament,the adnexa of the testes,and the spermatic cord;however,they rarely involve the stomach.We report an unusual case of a patient with an ectopic adrenal cortical adenoma in the gastric wall.The patient was a 72-year old female admitted to our hospital with upper abdominal discomfort.Physical examination revealed tenderness below the xiphoid process.Both computed tomography and fibergastroscopy revealed a mass on the lesser curvature side of the gastric antrum;it was initially diagnosed as a gastric stromal tumor.After adequate preparation,the patient underwent surgery.During the procedure,we found a 30 mm×30 mm mass with medium density in the lesser curvature near the gastric antrum within the serosa.Following immunohistochemistry examination, we corrected the diagnosis to an ectopic adrenal cortical adenoma;the tumor was nonfunctional.展开更多
文摘A 35-year-old woman with a history of regular menstruation presented with a positive urine pregnancy test and elevated blood human chorionic gonadotropin concentrations.Color Doppler ultrasound showed multiple slightly hyperechoic areas within the uterine cavity.She was admitted to the hospital with a preliminary outpatient diagnosis of“suspected molar pregnancy,pending further evaluation.”
基金Supported by the Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,No.NRF-RS-2023-00237287 and No.NRF-2021S1A5A8062526Local Government-University Cooperation-Based Regional Innovation Projects,No.2021RIS-003.
文摘Heterotopic mesenteric ossification(HMO)is a rare medical condition,with<100 cases reported globally by 2024.This disorder is characterized by abnormal bone tissue formation within the mesentery,often following abdominal trauma,ischemia,or infection.This editorial reviews the case presented by Zhang et al,involving a 34-year-old male who developed persistent left lower abdominal pain after sustaining blunt trauma to the abdomen.Diagnostic challenges arose due to the rarity and nonspecific presentation of HMO,which shares histopathological features with conditions such as myositis ossificans and necessitates differentiation from malignancies like sarcomas.Advanced imaging revealed calcifications suggestive of HMO,but definitive diagnosis was achieved only through surgical resection and histopathological analysis,which confirmed the presence of ectopic bone formation.Although benign,HMO can result in severe complications,such as bowel perforation or obstruction.Therefore,awareness of HMO is crucial for clinicians to ensure timely and appropriate treatment.
文摘BACKGROUND Congenital junctional ectopic tachycardia(CJET)is a rare but life-threatening arrhythmia in neonates and infants,often refractory to conventional antiar-rhythmic therapy.Ivabradine,a selective inhibitor of hyperpolarization-activated cyclic nucleotide-gated channels,has emerged as a promising drug for CJET management.AIM To evaluate the efficacy and safety of ivabradine in the management of CJET.Specifically,this study aims to analyze the dosing strategies,treatment outcomes,and the role of ivabradine as monotherapy or adjunct therapy in patients who have previously received other antiarrhythmic medications.Additionally,this review seeks to assess the impact of ivabradine on heart rate(HR)control,rhythm conversion,and its overall safety profile to provide evidence-based insights into its clinical use for CJET management.METHODS This systematic review aims to evaluate the outcomes of ivabradine,either as monotherapy or as an adjunctive therapy,in the treatment of CJET.A compre-hensive literature search was conducted across multiple electronic databases to identify relevant studies investigating the use of ivabradine in CJET.Stringent inclusion and exclusion criteria were applied to ensure the inclusion of high-quality,peer-reviewed studies.Data extraction and quality assessment were performed independently by two reviewers.RESULTS Ten studies,comprising 6 case reports,3 case series,and 1 cohort study,met the inclusion criteria.Ivabradine doses ranged from 0.025 to 0.28 mg/kg/dose,administered either as monotherapy or in combination with various antiar-rhythmic medications.Overall,ivabradine demonstrated promising results in achieving HR control,conversion to sinus rhythm,or stabilization of junctional rhythm.No significant adverse effects related to ivabradine were reported.CONCLUSION The available evidence suggests that ivabradine may be an effective adjunctive therapy or,in some cases,a potential monotherapy for the management of CJET,particularly in cases refractory to traditional antiarrhythmic medications.However,the current evidence is limited by the small sample sizes and retrospective nature of the included studies.Well-designed prospective studies with larger cohorts and longer follow-up periods are warranted to further elucidate the role of ivabradine in CJET management.
基金Supported by National Key Research and Development Project,No.2022YFC2503603and 985th Hospital Research Project,No.YN202405.
文摘Congenital gastric ectopic pylorus(CGEP),also known as gastric ectopic pyloric opening,is a rare congenital gastric abnormality.It was first reported and termed by Yu and Zhao from China in 1983,and in 2007,Uraz et al published the first report of CGEP in the English literature.We conducted a systemic review of the literature of CGEP published in English or Chinese,and found that CGEP occurred more frequently in the 6th and 7th decade of life,with a male predominance(89.7%).The majority of reported cases(89.2%)were from East Asia,and the underlying mechanism remains unknown.Most patients with CGEP presented non-specific symptoms,including abdominal pain,bloating,regurgitation,and belching.A few patients(30%)experienced upper gastrointestinal bleeding.Given the non-specific symptoms,misdiagnosis or underdiagnosis often occurs.Gastroscopy and upper gastrointestinal radiography are the main examinations used to confirm the diagnosis.Currently,conservative medication is the mainstay treatment.In this systematic review,we describe the history,etiology,diagnosis and treatment of CGEP in detail,aiming to provide a comprehensive understanding of this rare disease and avoid misdiagnosis.
基金Supported by the Air Force Medical Center Outstanding Youth Program,No.2022YXQNNO36.
文摘BACKGROUND Bleeding ectopic varices located in the small bowel(BEV-SB)caused by portal hypertension(PH)are rare and life-threatening clinical scenarios.The current management of BEV-SB is unsatisfactory.This retrospective study analyzed four cases of BEV-SB caused by PH and detailed the management of these cases using enteroscopic injection sclerotherapy(EIS)and subsequent interventional radiology(IR).AIM To analyze the management of BEV-SB caused by PH and develop a treatment algorithm.METHODS This was a single tertiary care center before-after study,including four patients diagnosed with BEV-SB secondary to PH between January 2019 and December 2023 in the Air Force Medical Center.A retrospective review of the medical records was conducted.The management of these four patients involved the utilization of EIS followed by IR.The management duration of BEV-SB in each patient can be retrospectively divided into three phases based on these two approaches:Phase 1,from the initial occurrence of BEV-SB to the initial EIS;phase 2,from the initial EIS to the initial IR treatment;and phase 3,from the initial IR to December 2023.Descriptive statistics were performed to clarify the blood transfusions in each phase.RESULTS Four out of 519 patients diagnosed with PH were identified as having BEV-SB.The management duration of each phase was 20 person-months,42 personmonths,and 77 person-months,respectively.The four patients received a total of eight and five person-times of EIS and IR treatment,respectively.All patients exhibited recurrent gastrointestinal bleeding following the first EIS,while no further instances of gastrointestinal bleeding were observed after IR treatment.The transfusions administered during each phase were 34,31,and 3.5 units of red blood cells,and 13 units,14 units,and 1 unit of plasma,respectively.CONCLUSION EIS may be effective in achieving hemostasis for BEV-SB,but rebleeding is common,and IR aiming to reduce portal pressure gradient may lower the rebleeding rate.
文摘BACKGROUND This case report presents an innovative approach to managing a complex class II division 1 malocclusion with ectopic maxillary canines using a modified twin block(TB)appliance.The modification facilitated simultaneous skeletal correction and canine eruption,reducing treatment time and improving patient satisfaction.CASE SUMMARY A 14-year-old male presented with concerns about a retruded chin and spacing between teeth.Clinical and radiographic evaluation revealed a class II division 1 malocclusion on a moderate class II skeletal base,with palatally impacted maxillary canines.Treatment involved a modified Clark TB appliance designed with hooks to allow active traction of the canines,followed by comprehensive fixed orthodontics.Over 18 months,the patient achieved improved occlusion,corrected overjet and overbite,successful eruption of the impacted canines,and enhanced facial aesthetics.The final results showed significant dental and skeletal improvement without requiring surgical intervention.CONCLUSION A modified TB appliance can effectively manage class II malocclusion with impacted canines in growing patients.The modified approach combining functional mandibular advancement and active canine traction represents a lessdocumented clinical adaptation,offering a valuable,efficient alternative to traditional two-phase interventions.
文摘Inflatable penile prosthesis(IPP)implantation is the gold standard treatment for patients with erectile dysfunction who are refractory to medical therapy.The standard placement of the reservoir in the space of Retzius(SOR)may be contraindicated in patients with prior pelvic or abdominal surgery due to altered anatomy and increased risk of complications.This has led to the development of alternative ectopic reservoir placement techniques.In this narrative review,we summarize the literature on various ectopic reservoir approaches,including low and high submuscular placements,submuscular techniques with counter incisions or transfascial fixation,midline submuscular placement,subcutaneous placement,and lateral retroperitoneal approaches.We describe the surgical methods,outcomes,and complication rates associated with each technique.While most methods demonstrate low complication and revision rates,direct comparisons remain limited due to heterogeneity and lack of prospective data.This review highlights the importance of individualized technique selection based on prior surgical history,body habitus,and surgeon experience.As ectopic placement becomes more widely adopted,familiarity with multiple approaches is essential for prosthetic surgeons.
文摘Cervical pregnancy is a rare clinical entity that accounts for less than 1% of all ectopic pregnancies. It results from implantation of the blastocyst in the cervical canal below the level of the internal os. Although non-tubal ectopic pregnancies account for only 5%<span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>of ectopics, they contribute to a significant morbidity. The cornerstone in the management of cervical ectopic is early diagnosis by high index of suspension and a qualified sonographer. Management options for cervical ectopic pregnancies range from conservative drug treatment to radical hysterectomy. Over the last few years, the mortality and morbidity rates of ectopic pregnancies have been reduced. This is mainly due to the early recognition of the condition and the wide availability of minimally invasive surgical procedures. We present a case of a 33-year-old</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>woman that was 16 weeks pregnant. She presented initially with recurrent vaginal bleeding followed by minimal lower abdominal pain. Her early US scans were</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>misleading. Several weeks later,</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>a follow up MRI scan suggested cervical ectopic. She was managed surgically with uterine preservation.</span></span></span>
文摘A 56-year-old man was found to have a pancreatic tail tumor. His blood chemistry showed no infection with hepatitis B or C virus and no elevations of tumor markers or pancreatic hormones. Abdominal ultrasound showed an encapsulated, rather heterogeneous, hypoechoic tumor, 6.5 cm in maximum diameter, with a beak sign. Helical dynamic CT revealed an irregularly enhanced tumor with pooling of contrast medium in the delayed phase. Abdominal angiography showed a hypervascular tumor. With a tentative diagnosis of non-functional islet-cell tumor, the patient underwent resection of the pancreatic body and tail with splenectomy. The contour of the liver and its surface were normal. In microscopic examination, tumor cells arranged in a trabecular pattern with focal bile pigment resembling hepatocellular carcinoma (HCC). Immunohistochemically, these tumor cells were positivefor HEPPAR-1, CAM5.2, cytokeratin 18 and COX-2, but negative for MUC-1, and cytokeratins 7, 20 and 8. These results supported a diagnosis of HCC without any adenocarcinoma component. The patient is currently doing well without any signs of recurrence in either the remaining pancreas or liver three years after surgery. We report the rare case with ectopic HCC in the pancreas with a review of the literature.
文摘Pregnancies in the same side tube after the same side ovary ovulation are more common. We report an unusual case of contralateral tubal ectopic pregnancy after ovulation of another side ovary in spontaneous cycles. A 32-year-old woman underwent laparoscopic left fallopian tube conservative surgery because of left tubal pregnancy two years ago. She returned to our hospital with a positive pregnancy test and lower abdominal pain 28 d after the dominant follicle discharged in the right side ovary detected by transvaginal ultrasound in spontaneous cycles. Transvaginal ultrasonography revealed no intrauterine gestational sac but a left adnexal mass measuring 2.6 cm X2.5 cm. Videolaparoscopy was performed, and the diagnosis of an ectopic pregnancy in the let fallopian tube was confirmed by pathologic report. Tubal damage is the most important risk factor for tubal ectopic pregnancy. Embryos can be reversely migrated toward fallopian tubes, due to retrograde action of endometrial waves and uterine contractions, that is another necessary reason which contributes to such tubal pregnancy. Total salpingectomy or tubal sterilization is necessary for avoiding repeated tubal ectopic pregnancy.
文摘BACKGROUND The ampulla of Vater is an opening at the confluence of the common bile duct and pancreatic duct.It is located in the second portion of the duodenum.An ectopic papilla of Vater is an anomalous termination.Few cases have been reported.We report the rare case of a man with an ectopic ampulla of Vater in the pylorus.CASE SUMMARY An 82-year-old man had experienced abdominal pain and fever with chills 1 d before his presentation.A computed tomography scan of the abdomen demonstrated dilatation of the common bile duct approximately 2.2 cm in width.Gas retention was found in his intrahepatic ducts.Acute cholangitis with pneumobilia was identified,and he was hospitalized.Esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography disclosed no ampulla of Vater in the second portion of the duodenum.Moreover,a capsule-like foreign body(pharmaceutical desiccant)approximately 1 cm×2 cm in size was found at the gastric antrum and peri-pyloric region.After the foreign body was removed,one orifice presented over the pyloric ring in the stomach,a suspected ectopic ampulla of Vater.Subsequently,sludge in the common bile duct was cleaned,and balloon dilatation was performed.The general condition improved daily.The patient was discharged in a stable condition and followed in our outpatient department.CONCLUSION This case involved an ampulla of Vater in an unusual location.Endoscopic retrograde cholangiopancreatography with balloon dilatation is the main treatment recommended and performed.
基金Supported by Pusan National University Research Grant for two years
文摘AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endoscopic ultrasonography before endoscopic resection.Endo-scopic resection was performed by two methods:endo-scopic mucosal resection(EMR)by the injection-and-cut technique or endoscopic mucosal dissection(ESD).RESULTS:We planned to perform EMR in all eight cases but EMR was successful in only four cases.In the other four cases,saline spread into surrounding normal tissues and the lesions becameattened,which made it impossible to remove them by EMR.Inthose four cases,we performed ESD and removed the lesions without any complications.CONCLUSION:If conventional EMR is difficult to remove gastric ectopic pancreas,ESD is a feasible alternative method for successful removal.
基金supported by the National Natural Science Foundation of China(No.81170574)the National Key Basic Research Development Plan of China(973 Program)(No.2007CB948104)+1 种基金Key Science and Technology Projects of Guangzhou(No.11C22120737)Comprehensive Strategic Sciences Cooperation Projects of Guangdong Province and Chinese Academy(No.04020416)
文摘This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy（EP） and heterotopic pregnancy（HP） after in vitro fertilization and embryo transfer（IVF-ET） in an attempt to reduce the diagnostic error. Clinical data of patients who underwent IVF-ET treatment and had clinical pregnancy from 12463 cycles were retrospectively analyzed. Their findings of serum β-hCG test and transvaginal ultrasonography were also obtained during follow-up. These patients were divided into two groups according to the diagnosis accuracy of EP/HP： early diagnosis and misdiagnosis/delayed diagnosis. The results showed that the incidence of EP and HP was 3.8%（125/3286） and 0.8%（27/3286） respectively for IVF/ICSI-ET cycle, and 3.8%（55/1431） and 0.7%（10/1431） respectively for frozen-thawed embryo transfer（FET） cycle. Ruptured EP occurred in 28 patients due to initial misdiagnosis or delayed diagnosis. Related factors fell in 3 categories：（1） clinician factors： misunderstanding of patients＇ medical history, insufficient training in ultrasonography and unawareness of EP and HP;（2） patient factors： noncompliance with medical orders and lack of communication with clinicians;（3） complicated conditions of EP： atypical symptoms, delayed elevation of serum β-hCG level, early rupture of cornual EP, asymptomatic in early gestation and pregnancy of unknown location. All the factors were interwoven, contributing to the occurrence of EP and HP. It was concluded that complicated conditions are more likely to affect the diagnosis accuracy of EP/HP after IVF-ET. Transvaginal ultrasonography should be performed at 5 weeks of gestation. Intensive follow-up including repeated ultrasonography and serial serum β-hCG tests should be performed in patients with a suspicious diagnosis at admission.
文摘AIM:To study the clinical,endoscopic,sonographic,and cytologic features of ectopic pancreas(EP).METHODS:This was a retrospective study performedat an academic referral center including two hospitals.Institutional review board approval was obtained.Patients referred to the University Hospital or Denver Health Medical Center Gastrointestinal Endoscopy Lab for gastroduodenal subepithelial lesions(SEL)with a final diagnosis of EP between January 2009and December 2013 were identified.Patients in this group were selected for the study if they underwent endoscopic ultrasound(EUS)with fine-needle aspiration(FNA)or deep biopsy.A review of the medical record was performed specifically to review the following information:presenting symptoms,endoscopic and EUS findings,computed tomography or magnetic resonance imaging findings,pathology results,procedure-related adverse events,and subsequent treatments after EUSFNA.EUS with FNA or deep submucosal biopsy was performed in all patients on an outpatient basais by one of two physicians(Attwell A,Fukami N).Review of all subsequent clinic notes and operative reports was performed in order to determine follow-up and final diagnoses.RESULTS:Between July 2009 and December 2013,10patients[3 males,7 females,median age 52(26-64)years]underwent EUS for a gastroduodenal SEL and were diagnosed with EP.One patient was symptomatic.Six(60%)lesions were in the antrum,3(30%)in the body,and 1(10%)in the duodenum.A mucosal dimple was noted in 6(60%).Mean lesion size was 17(8-25)mm.Gastrointestinal wall involvement:muscularis mucosae,10%;submucosa,70%;muscularis propria,60%;and serosa,10%.Nine(90%)lesions were hypoechoic and 5(50%)were homogenous.A duct was seen in 5(50%).FNA was attempted in 9(90%)and successful in 8(80%)patients after 4(2-6)passes.Cytology showed acini or ducts in 7 of 8(88%).Superficial biopsies in 7 patients(70%)showed normal gastric mucosa.Deep endoscopic biopsies were taken in 2 patients and diagnostic in one.One patient(10%)developed pancreatitis after EUS-FNA.Two patients(20%)underwent surgery to relieve symptoms or confirm the diagnosis.The main limitation of the study was the fact that it was retrospective and performed at a single medical center.CONCLUSION:EUS features of EP include antral location,mucosal dimple,location in layers 3-4,and lesional duct,and FNA or biopsy is accurate and effective.
基金supported by a grant provided by Southeast University(No.9224007044)
文摘Insulin resistance is the pathophysiological basis of many diseases.Overcoming early insulin resistance highly significant in prevention diabetes,non-alcoholic fatty liver,and atherosclerosis.The present study aimed at evaluating the therapeutic effects of baicalin on insulin resistance and skeletal muscle ectopic fat storage in high fat diet-induced mice,and exploring the potential molecular mechanisms.Insulin resistance in mice was induced with a high fat diet for 16 weeks.Animals were then treated with three different doses of baicalin(100,200,and 400 mg·kg^(-1)·d^(-1)for 14 weeks.Fasting blood glucose,fasting serum insulin,glucose tolerance test(GTT),insulin tolerance test(ITT),and skeletal muscle lipid deposition were measured.Additionally,the AMP-activated protein kinase/acetyl-CoA carboxylase and protein kinase B/Glycogen synthase kinase 3 beta pathways in skeletal muscle were further evaluated.Baicalin significantly reduced the levels of fasting blood glucose and fasting serum insulin and attenuated high fat diet induced glucose tolerance and insulin tolerance.Moreover,insulin resistance was significantly reversed.Pathological analysis revealed baicalin dose-dependently decreased the degree of the ectopic fat storage in skeletal muscle.The properties of baicalin were mediated,at least in part,by inhibition of the AMPK/ACC pathway,a key regulator of de novo lipogenesis and activation of the Akt/GSK-3β pathway,a key regulator of Glycogen synthesis.These data suggest that baicalin,at dose up to 400 mg·kg^(-1)·d^(-1),is safe and able to attenuate insulin resistance and skeletal muscle ectopic fat storage,through modulating the skeletal muscle AMPK/ACC pathway and Akt/GSK-3β pathway.
文摘AIM:To evaluate the efficacy of human thrombin in the treatment of bleeding gastric and ectopic varices.METHODS:Retrospective observational study in a Tertiary Referral Centre.Between January 1999-October 2005,we identified 37 patients who were endoscopically treated with human thrombin injection therapy for bleeding gastric and ectopic varices.Patient details including age,gender and aetiology of liver disease/segmental portal hypertension were documented.The thrombin was obtained from the Scottish National Blood Transfusion Service and prepared to give a solution of 250 IU/mL which was injected via a standard injection needle.All patient case notes were reviewed and the total dose of thrombin given along with the number of endoscopy sessions was recorded.Initial haemostasis rates,rebleeding rates and mortality were catalogued along with the incidence of any immediate complications which could be attributable to the thrombin therapy.The duration of follow up was also listed.The study was conducted according to the United Kingdom research ethics guidelines.RESULTS:Thirty-seven patients were included.33 patients(89%) had thrombin(250 U/mL) for gastric varices,2(5.4%) for duodenal varices,1 for rectal varices and 1 for gastric and rectal varices.(1) Gastric varices,an average of 15.2 mL of thrombin was used per patient.Re-bleeding occurred in 4 patients(10.8%),managed in 2 by a transjugular intrahepatic portosystemic shunt(TIPSS)(one unsuccessfully who died) and in other 2 by a distal splenorenal shunt;(2) Duodenal varices(or type 2 isolated gastric varices),an average of 12.5 mL was used per patient over 2-3 endoscopy sessions.Re-bleeding occurred in one patient,which was treated by TIPSS;and(3) Rectal varices,an average of 18.3 mL was used per patient over 3 endoscopy sessions.No re-bleeding occurred in this group.CONCLUSION:Human thrombin is a safe,easy to use and effective therapeutic option to control haemorrhage from gastric and ectopic varices.
文摘Ectopic varices are unusual with portal hypertension and can involve any site along the digestive tract outside the gastroesophageal region. Hemorrhage from ectopic varices generally are massive and life threatening.Diagnosis of ectopic varices is difficult and subsequent treatment is also difficult; the optimal treatment has not been established. Recently, interventional radiology and endoscopic treatments have been carried out successfully for hemorrhage from ectopic varices.
文摘BACKGROUND Ectopic pregnancy(EP) is one of the most common acute abdominal diseases in gynecology. Once the condition of EP is delayed, it may lead to massive hemorrhage, shock, and even death in a short time, seriously threatening the patient’s life. Early diagnosis is the key to preventing and improving the prognosis of EP.Transabdominal ultrasound(TAS) and transvaginal ultrasound(TVS) are the main diagnostic methods for abdominal diseases. The purpose of this study is to explore the application value and effect of TAS and TVS in the diagnosis of EP,hoping to provide more valuable references for the diagnosis of EP.AIM To explore the application value of TAS and TVS in the diagnosis of EP and to improve the level of clinical diagnosis.METHODS A total of 140 patients with EP admitted to our hospital from July 2018 to July 2020 were selected for this study. All patients were divided into two groups according to the examination methods. 63 patients who underwent abdominal ultrasound examination were set as the TAS group, while 77 patients who underwent TVS examination were set as the TVS group. We compared the diagnostic accuracy and misdiagnosis rates between the two types of ultrasound examinations, as well as the postoperative pathological results of the two diagnostic methods for different types of ectopic pregnancies. We also analyzed the sonograms for the presence of mixed ectopic masses,adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the ectopic sac shadow, and the detection of fluid in the rectal fossa of the uterus, such as the adnexal area, yolk sac, and embryo, etc. In addition, the diagnosis time, days of gestational sac appearance, operation time, endometrial thickness, and blood flow resistance index were compared as well.RESULTS After performing both types of ultrasound examinations in 140 patients with EP, we found that the diagnostic accuracy of TVS was significantly higher than that of TAS, and the misdiagnosis rate was significantly lower than that of TAS. The differences were statistically significant(P < 0.05). In addition, the detection rate of TVS was better than that of TAS for the presence of mixed masses,adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the shadow of the ectopic sac, and sonograms such as the adnexal area, yolk sac, and embryo,etc. The coincidence rate of its postoperative pathological examination results was significantly higher than those of TAS. The diagnosis time and the days of gestational sac appearance by TVS were significantly shorter than that by TAS, and the operation time was earlier than that by TAS.What’s more, the detection rates of the endometrial thickness ￡ 1.5 mm and blood flow resistance ￡0.5 were significantly higher in TVS diagnosis of EP than in TAS. All differences were statistically significant(P < 0.05).CONCLUSION Compared with TAS, TVS has the advantages of high detection accuracy and good sonogram performance.
文摘Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain,followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultraso-nography (EUS),which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and surgery.As far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain,choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed.
文摘Ectopic adrenal cortical neoplasms are extremely rare. Ectopic adrenocortical tissue can be found in locations such as the celiac axis,the broad ligament,the adnexa of the testes,and the spermatic cord;however,they rarely involve the stomach.We report an unusual case of a patient with an ectopic adrenal cortical adenoma in the gastric wall.The patient was a 72-year old female admitted to our hospital with upper abdominal discomfort.Physical examination revealed tenderness below the xiphoid process.Both computed tomography and fibergastroscopy revealed a mass on the lesser curvature side of the gastric antrum;it was initially diagnosed as a gastric stromal tumor.After adequate preparation,the patient underwent surgery.During the procedure,we found a 30 mm×30 mm mass with medium density in the lesser curvature near the gastric antrum within the serosa.Following immunohistochemistry examination, we corrected the diagnosis to an ectopic adrenal cortical adenoma;the tumor was nonfunctional.
