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将卒中纳入心血管风险预测工具美国心脏协会／美国卒中协会对医疗卫生专业人员的声明

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国际脑血管病杂志 2012年第11期20卷 801-828页

作者： Daniel T. Lackland mitchell s.v. elkind Ralph D'Agostino sr Mandip s. Dhamoon David C. Goff Jr Randall T. Higashida Leslie A. McClure Pamela H. mitchell Ralph L. sacco Cathy A. sila sidney C. smith Jr David Tanne David L. Tirschwell Emmanuel Touze Lawrence R. Wechsler 4:~ 尤寿江(译) 于海龙(译) 刘慧慧(译) 张霞(译) 刘春风(译) 代表美国心脏协会卒中委员会、流行病学和预防委员会、心血管放射学和介入委员会、心血管护理委员会、周围血管病委员会以及医疗质量和转归研究委员会苏州大学附属第二医院神经内科 215004

背景和目的目前美国针对心血管事件风险预测以及一级和二级预防的指南声明均使用绝对风险估计值来识别血管事件高危患者以及可从特定干预措施中获益的患者。然而，这些指南并未明确地包括卒中患者。本指南对现有证据和争论进行概述以支... 详细信息

背景和目的目前美国针对心血管事件风险预测以及一级和二级预防的指南声明均使用绝对风险估计值来识别血管事件高危患者以及可从特定干预措施中获益的患者。然而，这些指南并未明确地包括卒中患者。本指南对现有证据和争论进行概述以支持：（1）将卒中（尤其是动脉粥样硬化性卒中）患者纳入心血管病绝对风险增高的患者群体；（2）将卒中纳入血管性疾病风险预测工具的转归预测因素。方法和结果写作组成员由委员会联合主席基于先前在相关领域的研究成果来提名，并得到美国心脏协会（American Heart Association，AHA）卒中委员会科学声明监督委员会以及文稿监督委员会的批准。作者采用系统文献回顾（覆盖1980年1月至2010年3月期间的文献）并参考以往公布的指南、个人资料以及专家观点，以归纳现有证据，提出当前知识的不足，并根据AHA标准对适当的问题制定推荐意见。所有写作组成员均有机会对推荐意见进行评论并批准了最终版本。经广泛的AHA内部同行评议以及卒中委员会领导阶层和科学声明监督委员会的审阅后，最终获得AHA科学咨询和协调委员会的批准。将卒中患者（尤其是动脉粥样硬化性卒中患者）纳入冠状动脉和心血管病绝对高危人群的原因如下。首先，有证据显示，缺血性卒中患者发生致死性和非致死性心肌梗死或猝死的绝对风险增高，10年绝对风险≥20％，这一风险阈值已被一些指南用于定义冠状动脉疾病风险等危症。其次，纳入动脉粥样硬化性卒中的原因与纳入糖尿病、周围血管病、慢性肾脏病以及其他动脉粥样硬化性疾病的原因相同，尽管尚缺乏在所有人群或患者中风险增高的统一证据。再次，缺血性卒中的大动脉粥样硬化性卒中亚型与其他这些疾病的病理生理学机制相同。将卒中纳入高危因素将导致高危人群的数量扩大约10％。然而，由于卒中的异质性，尚不确定其他卒中亚型，包括出血性卒中以及非动脉粥样硬化性卒中亚型，是否应被视为具有相同水平的风险，因此有待进一步研究。鉴于卒中对残疾和死亡的影响、卒中与其他血管性疾病预防措施的相似性以及卒中在某些人群中较冠状动脉疾病更高的重要性，将卒中、心肌梗死和猝死纳入心血管事件风险预测工具的转归预测因素是合适的。美国以外的指南常常将卒中患者纳入心血管高危人群，并将卒中作为心脏终点的一个相关转归事件。结论动脉粥样硬化性卒中患者应被纳入会进一步发生冠状动脉粥样硬化事件的高危患者（10年≥20％）。是否应纳入非动脉粥样硬化卒中亚型尚不确定。对于一级预防，缺血性卒中应被纳入绝对风险评估方案的心血管疾病转归事件。将动脉粥样硬化性卒中作为一个高危因素或者更宽泛地将缺血性卒中视作一种转归事件纳入，可能对心血管病的预防具有重要意义，因为被评定为高危风险的患者数量将大幅增加。

关键词： AHA科学声明心血管疾病危险性评估风险预测卒中

Two case reports of novel syndrome of bizarre performance of gastrointestinal endoscopy due to toxic encephalopathy of endoscopists among 181767 endoscopies in a 13-year-university hospital review: Endoscopists, first do no harm!

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World Journal of Gastroenterology 2020年第9期26卷 984-991页

作者： mitchell s Cappell Division of Gastroenterology & Hepatology William Beaumont Hospital Oakland University William Beaumont school of Medicine

BACKGROUND Although deficient procedures performed by impaired physicians have been reported for many specialists,such as surgeons and anesthesiologists,systematic literature review failed to reveal any reported cases of deficient endoscopies performed by gastroenterologists due to toxic *** gastroenterologists,like any individual,can rarely suffer acute-changes-inmental-status from medical disorders,and these disorders may first manifest while performing gastrointestinal endoscopy because endoscopy comprises so much of their *** sUMMARIEs Among 181767 endoscopies performed by gastroenterologists at William-Beaumont-Hospital at Royal-Oak,two endoscopies were performed by normally highly qualified endoscopists who manifested bizarre endoscopic interpretation and technique during these endoscopies due to toxic ***-1-endoscopist repeatedly insisted that gastric polyps were colonic polyps,and absurdly“pressed”endoscopic steering dials to“take”endoscopic photographs;Case-2-endoscopist repeatedly insisted that had intubated duodenum when intubating antrum,and wildly turned steering dials and bumped endoscopic tip forcefully against antral *** nurses recognized endoscopists as impaired and informed *** called Chief-of-Gastroenterology who advised endoscopists to terminate their esophagogastroduodenoscopies(fulfilling ethical imperative of“physician,firstdo-no-harm”),and go to emergency room for medical *** endoscopists ***-hospital-work-up revealed toxic encephalopathy in both from:case-1-urosepsis and left-ureteral-impacted-nephrolithiasis;and case-2-dehydration and accidental ingestion of suspected illicit drug given by unidentified *** rapidly recovered with medical *** This rare syndrome(0.0011%of endoscopies)may manifest abruptly as bizarre endoscopic interpretation and technique due to impairment of endoscopists by toxic encephalopathy.

关键词： Endoscopy Iatrogenic injury Medical ethics Hippocratic Oath Quality improvement Medical malpractice Morbidity and mortality

Distinctive aspects of peptic ulcer disease,Dieulafoy'slesion,and Mallory-Weiss syndrome in patients withadvanced alcoholic liver disease or cirrhosis

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World Journal of Gastroenterology 2016年第1期22卷 446-466页

作者： Borko Nojkov mitchell s Cappell Division of Gastroenterology and Hepatology William Beaumont HospitalRoyal OakMI 48073United States Oakland University William Beaumont school of Medicine Royal OakMI 48073United States

AIM:To systematically review the data on distinctive aspects of peptic ulcer disease(PUD),Dieulafoy’s lesion(DL),and Mallory-Weiss syndrome(MWs)in patients with advanced alcoholic liver disease(a ALD),including alcoholic hepatitis or alcoholic ***:Computerized literature search performed via Pub Med using the following medical subject heading terms and keywords:"alcoholic liver disease","alcoholic hepatitis","alcoholic cirrhosis","cirrhosis","liver disease","upper gastrointestinal bleeding","nonvariceal upper gastrointestinal bleeding","PUD",‘‘DL’’,‘‘Mallory-Weiss tear",and"MWs’’.REsULTs:While the majority of acute gastrointestinal(GI)bleeding with a ALD is related to portal hypertension,about 30%-40%of acute GI bleeding in patients with a ALD is unrelated to portal *** bleeding constitutes an important complication of a ALD because of its frequency,s.v.rity,and associated *** with cirrhosis have a markedly increased risk of PUD,which further increases with the progression of *** with cirrhosis or a ALD and peptic ulcer bleeding(PUB)have worse clinical outcomes than other patients with PUB,including uncontrolled bleeding,rebleeding,and *** consumption,nonsteroidal anti-inflammatory drug use,and portal hypertension may have a pathogenic role in the development of PUD in patients with a *** data suggest that Helicobacter pylori does not play a significant role in the pathogenesis of PUD in most cirrhotic *** frequency of bleeding from DL appears to be increased in patients with a *** may be associated with an especially high mortality in these *** is strongly associated with heavy alcohol consumption from binge drinking or chronic alcoholism,and is associated with a *** with a ALD have more s.v.re MWs bleeding and are more likely to rebleed when compared to *** management of acute GI bleeding in patients with a ALD unrelated to portal

关键词： Alcoholic liver disease Alcoholic hepatitis Cirrhosis Portal hypertension Peptic ulcer disease Mallory-Weiss syndrome Dieulafoy lesion Endoscopictherapy

Therapy for alcoholic liver disease

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World Journal of Gastroenterology 2014年第9期20卷 2143-2158页

作者： Maryconi M Jaurigue mitchell s Cappell Division of Gastroenterology and Hepatology Department of Internal MedicineWilliam Beaumont Hospital Royal Oak MI 48073 United States Oakland University William Beaumont school of Medicine Royal Oak MI 48073 United States

Alcoholism results in about 2.5 million deaths annually worldwide, representing 4% of all mortality. Although alcoholism is associated with more than 60 diseases, most mortality from alcoholism results from alcoholic liver disease (ALD). ALD includes alcoholic steatosis, alcoholic hepatitis, and alcoholic cirrhosis, in order of increasing s.v.rity. Important scoring systems of ALD s.v.rity include: Child-Pugh, a semi-quantitative scoring system useful to roughly characterize clinical s.v.rity; model for end-stage liver disease, a quantitative, objective scoring system used for prognostication and prioritization for liver transplantation; and discriminant function, used to determine whether to administer corticosteroids for alcoholic hepatitis. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including twelve-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Disulfiram decreases alcohol consumption by causing unpleasant sensations after drinking alcohol from accumulation of acetaldehyde in serum, but disulfiram can be hepatotoxic. Adjunctive pharmacotherapies to reduce alcohol consumption include naltrexone, acamprosate, and baclofen. Nutritional therapy helps reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. Although reduced protein intake was previously recommended for advanced ALD to prevent hepatic encephalopathy, a diet containing 1.2-1.5 g of protein/kg per day is currently recommended to prevent muscle wasting. Corticosteroids are first-line therapy for s.v.re alcoholic hepatitis (discriminant function ≥ 32), but proof of their efficacy in decreasing mortality remains elus.v.. Pentoxifylline is an alternative therapy. Complications of advanced ALD include ascites, spontaneous bacterial peritonitis, esophageal variceal bleeding, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, and portopu

关键词： Alcoholic liver disease Alcoholic steatosis Alcoholic hepatitis Alcoholic cirrhosis Alcoholism Liver disease Corticosteroids Pentoxifylline Liver transplantation

stricter national standards are required for credentialing of endoscopic-retrograde-cholangiopan-creatography in the United states

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World Journal of Gastroenterology 2019年第27期25卷 3468-3483页

作者： mitchell s Cappell David M Friedel Division of Gastroenterology and Hepatology William Beaumont HospitalRoyal OakMI 48073United States Oakland University William Beaumont school of Medicine William Beaumont HospitalMI 48073United States Division of Gastroenterology New York University Winthrop Medical CenterMineolaNY 11501United States

Endoscopic-retrograde-cholangiopancreatography(ERCP) is now a vital modality with primarily therapeutic and occasionally solely diagnostic utility for numerous biliary/pancreatic disorders. It has a significantly steeper learning curve than that for other standard gastrointestinal(GI) endoscopies, such as esophagogastroduodenoscopy or colonoscopy, due to greater technical difficulty and higher risk of complications. Yet, GI fellows have limited exposure to ERCP during standard-three-year-GI-fellowships because ERCP is much less frequently performed than esophagogastroduodenoscopy/colonoscopy. This led to adding an optional year of training in therapeutic endoscopy. Yet many graduates from standard three-year-fellowships without advanced training intensely pursue independent/unsupervised ERCP privileges despite inadequate numbers of performed ERCPs and unacceptably low rates of successful selective cannulation of desired(biliary or pancreatic) duct. Hospital credentialing committees have traditionally performed ERCP credentialing, but this practice has led to widespread flouting of recommended guidelines(e.g., planned privileging of applicant with 20% successful cannulation rate, or after performing only 7 ERCPs);and intense politicking of committee members by applicants, their practice groups, and potential competitors. Consequently, some gastroenterologists upon completing standard fellowships train and learn ERCP 'on the job' during independent/unsupervised practice, which can result in bad outcomes: high rates of failed bile duct cannulation. This s.v.re clinical problem is indicated by publication of ≥ 12 ERCP competency studies/guidelines during last 5 years. However, lack of mandatory, quantitative, ERCP credentialing criteria has permitted neglect of recommended guidelines. This work comprehens.v.ly reviews literature on ERCP credentialing;reviews rationales for proposed guidelines;reports problems with current system;and proposes novel criteria for competenc

关键词： Endoscopic retrograde cholangiopancreatography Privileges Credentialing Gastroenterology fellowship training Advanced gastrointestinal endoscopy training Certification standards

卒中一级预防指南美国心脏协会／美国卒中协会对医疗专业人员的声明

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国际脑血管病杂志 2015年第7期23卷 403-439页

作者： James F. Meschia Cheryl Bushnell Bernadette Boden-Albala Lynne T. Braun Dawn M. Bravata seemant Chaturvedi Mark A. Creager Robert H. Eckel mitchell s.v. elkind Myriam Fornage Larry B Goldstein steven M. Greenberg susanna E. Horvath Costantino Iadecola Edward C. Jauch Wesley s. Moore John A. Wilson 李迪高一鹭陈政弘霍晓川孙海欣孙冬玲茹小娟江滨代表美国心脏协会卒中委员会、心血管和卒中护理委员会、临床心脏病学委员会、功能基因组学和生物转化委员会以及高血压委员会北京市神经外科研究所首都医科大学首都医科大学附属北京天坛医院临床流行病学北京市重点实验室 100050

这份更新版指南旨在为既往无卒中或短暂性脑缺血发作史的人群提供适时的综合性卒中预防循证建议，包括危险因素控制、头颈部动脉粥样硬化性疾病的干预方法以及预防血栓形成和血栓栓塞性卒中的抗栓治疗。此外，本指南还提供了针对遗传和... 详细信息

这份更新版指南旨在为既往无卒中或短暂性脑缺血发作史的人群提供适时的综合性卒中预防循证建议，包括危险因素控制、头颈部动脉粥样硬化性疾病的干预方法以及预防血栓形成和血栓栓塞性卒中的抗栓治疗。此外，本指南还提供了针对遗传和药理学检测以及在其他特殊情况下（包括镰状细胞疾病和卵圆孔未闭）进行卒中预防的建议。

关键词： AHA/AsA科学声明 AF 糖尿病高脂血症高血压颅内动脉瘤缺血预防与控制吸烟卒中

Limited, local, extracolonic spread of mucinous appendiceal adenocarcinoma after perforation with formation of a malignant appendix-to-sigmoid fistula: Case report and literature review

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World Journal of Gastroenterology 2016年第38期22卷 8624-8630页

作者： seifeldin Hakim Mitual Amin mitchell s Cappell Division of Gastro-enterology and Hepatology Department of Internal MedicineWilliam Beaumont Hospital Royal Oak MI 48073 Unites States Department of Pathology William Beaumont Hospital Royal Oak MI 48073 Unites States Oakland University William Beaumont school of Medicine Royal Oak MI 48073 Unites States

A 68-year-old man presented with progress.v. right lower quadrant abdominal pain and tenderness without rebound tenderness, and with constipation during the prior 9 mo. Abdomino-pelvic computed tomography and magnetic resonance imaging demonstrated a dilated appendix forming a fistula to the sigmoid colon. Open laparotomy revealed a bulky abdominal tumor involving appendix, cecum, and sigmoid, and extending up to adjacent viscera, without ascites or peritoneal implants. The abdominal mass was removed en bloc, including resection of sigmoid colon, cecum(with preservation of ileocecal valve), appendix, right vas deferens, testicular vessels, and minimal amounts of anterior abdominal wall; and shaving off of small parts of the walls of the urinary bladder and small bowel. Gross and microscopic pathologic examination revealed an appendix-to-sigmoid malignant fistula secondary to perforation of mucinous adenocarcinoma of the appendix with minimal local spread(stage T4). However, the surgical margins were clear, all 13 resected lymph nodes were cancer-free, and pseudomyxoma peritonei or peritoneal implants were not present. The patient did well during 1 year of follow-up with no clinical or radiologic evidence of local recurrence, metastases, or pseudomyxoma peritonei despite presenting with extens.v. stage T4 cancer that was debulked without administering chemotherapy, and despite presenting with malignant appendiceal perforation. This case illustrates the non-aggress.v. biologic behavior of this low-grade malignancy. The fistula may have prevented free spillage of cancerous cells and consequent distant metastases by containing the appendiceal contents largely within the colon.

关键词： Mucinous adenocarcinoma Appendicitis Appendix Malignant fistula Pseudomyxoma peritonei Colon cancer Metastases

Characteristic clinical features of Aspergillus appendicitis:Case report and literature review

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World Journal of Gastroenterology 2015年第44期21卷 12713-12721页

作者： Mihajlo Gjeorgjievski Mitual B Amin mitchell s Cappell Division of Gastroenterology and Hepatology William Beaumont Hospital Anatomic Pathology William Beaumont Hospital Oakland University William Beaumont school of Medicine

This work aims to facilitate diagnosing Aspergillus appendicitis, which can be missed clinically due to its rarity, by proposing a clinical pentad for Aspergillus appendicitis based on literature review and one new case. The currently reported case of pathologicallyproven Aspergillus appendicitis was identified by computerized search of pathology database at William Beaumont Hospital, 1999-2014. Prior cases were identified by computerized literature search. Among 10980 pathology reports of pathologically-proven appendicitis, one case of Aspergillus appendicitis was identified(rate = 0.01%). A young boy with profound neutropenia, recent chemotherapy, and acute myelogenous leukemia presented with right lower quadrant pain, pyrexia, and generalized malaise. Abdominal computed tomography scan showed a thickened appendiceal wall and periappendiceal inflammation, suggesting appendicitis. Emergent laparotomy showed an inflamed, thickened appendix, which was resected. The patient did poorly postoperatively with low-grade-fevers while receiving antibacterial therapy, but rapidly improved after initiating amphotericin therapy. Microscopic examination of a silver stain of the appendectomy specimen revealed fungi with characteristic Aspergillus morphology, findings confirmed by immunohistochemistry. Primary Aspergillus appendicitis is exceptionally rare, with only 3 previously reported cases. All three cases presented with(1)-neutropenia,(2)-recent chemotherapy,(3)-acute leukemia, and(4)-suspected appendicitis;(5)-the two prior cases initially treated with antibacterial therapy, fared poorly before instituting antiAspergillus therapy. The current patient satisfied all these five criteria. Based on these four cases, a clinical pentad is proposed for Aspergillus appendicitis: clinically-suspected appendicitis, neutropenia, recent chemotherapy, acute leukemia, and poor clinical response if treated solely by antibacterial/anti-candidial therapy. Patients presenting with this propos

关键词： Aspergillosis Aspergillus appendicitis Fungal appe

systematic review of giant gastric lipomas reported since 1980 and report of two new cases in a review of 117110 esophagogastroduodenoscopies

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World Journal of Gastroenterology 2017年第30期23卷 5619-5633页

作者： mitchell s Cappell Charlton E stevens Mitual Amin Department of Gastroenterology and Hepatology William Beaumont Hospital Oakland University William Beaumont school of Medicine san Antonio Military Medical Center Department of Pathology William Beaumont Hospital

To systematically review the syndrome of giant gastric lipomas, report 2 new illustrative *** systematically reviewed using PubMed for publications since 1980 with following medical subject heading/keywords: (“giant lipoma”) AND (“gastric”) OR [(“lipoma”) and (“gastric”) and (“bleeding”)]. Two authors independently reviewed literature, and decided by consensus which articles to incorporate. Computerized review of pathology/endoscopy records at William Beaumont Hospitals, Royal Oak and Troy, Michigan, January 2005-December 2015, revealed 2 giant gastric lipomas among 117110 consecutive esophagogastroduodenoscopies (EGDs), which were thoroughly reviewed, including re-review of original endoscopic photographs, radiologic images, and pathologic slides.

关键词： Esophagogastroduodenoscopy Lipoma Gastric Giant Melena Upper gastrointestinal bleeding systematic review