内镜下巧取食管及胃内异物病例分析

1　一般资料患者年龄最小 3岁 ,最大 6 2岁 ,平均 32 .5岁。异物有钢笔、牙刷、钢针、硬币、假牙、钢板、钥匙等。食管 9例 ,胃内 19例。使用仪器为 :XionPV -SG2 8电子胃镜 ,OlimpusXQ30纤维胃镜 ,胃内手术器械、胃管、结扎器外套管。麻醉方法为 :儿童可局麻结合肌注安定 ,小于 5岁儿童可术前肌注氯胺酮全麻 ,成人咽腔 2 %利多卡因胶浆局部麻醉。2　病例介绍例 1:男 ,6 2岁 ,假牙吞入胃内 3h。考虑到假牙带弯曲的钢丝 ,容易损伤食管及胃黏膜 ,我们利用结扎器套管配合胃镜取异物。患者常规利多卡因咽部麻醉 ,将胃镜套入外套管 ,然后将胃…     

急诊胃镜取食管异物55例临床观察与分析

目的：总结急诊胃镜治疗食管异物的可行性和成败经验。方法：分析急诊胃镜取食管异物55例临床资料。结果：53例异物成功取出,2例钳碎后掉入胃内,无并发症。结论：急诊胃镜取食管异物安全可靠,成功率高,应作为食管异物的首选治疗方法。但对异物刺入食管壁内深且固定、食管异物嵌顿时间长、穿孔风险大者应改为手术治疗。     

经胃镜取上消化道异物8例

2000年1月至2002年10月应用胃镜取出食道、胃内异物8例,获得满意疗效,现报告如下。 1 临床资料 男6例,女2例,年龄18～25岁。食道异物停滞部位:上段4例,中段2例,下段1例。胃内异物1例,位于胃底部。异物种类有:鱼刺4根,鸡腿骨1根,猪骨1块,义齿1个,金戒子1个。     

内镜钳取上消化道异物105例体会

1995年10月至2006年9月,我们忠县应用胃镜钳取上消化道异物的105例,取得较为满意的效果,现将操作体会报告如下。1临床资料本组105例,男42例,女63例,年龄最小3岁,最大72岁,其中7岁以下71例;异物分类:金属46例、骨片17例、鱼刺16例、塑料制品10例、肉团9例、木(竹)棍7例;异物停留部位:食管上段96例、中段3例、下段1例、胃底3例、胃窦1例、十二指肠球部1例。     

急诊内镜取异物5例体会

1　临床资料11　我院1988～1992年共急诊胃镜取异物5例,年龄最小17岁,最大45岁。其中食管异物2例,1例未找到异物。异物包括缝衣针、鸡骨、竹筷、假牙、折刀等。异物吞入时间最短4小时,最长1周。12　方法及器械:口服咽部麻醉,用国产ＸＳ—4型或日本欧林巴斯ＧＩＦ—ＸＱ10...     

咽部鱼刺的处理

咽部鱼刺 2 86例中男 13 5例 ,女 15 1例 ;3～ 65岁 ,病程 10ｍｉｎ～ 7ｄ。经反复检查未发现鱼刺 3 0例 ,确诊 2 5 6例 ;鱼刺分布于扁桃体区 12 2例 ,舌根 3 0例 ,会厌谷 85例 ,下咽侧壁 14例 ,梨状窝区 5例。口咽部鱼刺用压舌板压舌后用枪状镊取出 ;舌根及下咽部鱼刺表麻后在间接喉镜下用间接喉钳取出 ,其中 5例因鱼刺外露较少在纤维喉镜下用活检钳取出 ,异物取出后症状立即消失。未发现鱼刺者 ,给予西瓜霜含化 ,3ｄ后复查症状消失。讨　论　咽部鱼刺病史明确 ,患者均能指出鱼刺所在部位 ,治疗不难。想通过吞咽饭菜将鱼刺带下者 ,吞咽时由…     

经胃镜处理上消化道异物50例分析

1995～ 2 0 0 1年 ,我院经胃镜取出上消化道异物 50例 ,效果较好 ,现报告如下。1　临床资料1 .1　一般资料本组 50例病人中 ,男 39例 ,女 1 1例 ;年龄 4～ 88岁 ,平均 54岁。其中食管异物 2 1例 (包括硬币、义齿、竹筷、鸡骨、海螺、鱼骨等 ) ,胃内异物 2 5例 (包括理发剪、线剪、义齿、鸡骨、柿石、山楂石、柿子牛肉混合石及钡石等 ) ,残胃吻合口缝线残留 4例。异物最长者 2 5ｃｍ ,最大者 8ｃｍ× 8ｃｍ× 7ｃｍ ,最多者有 7枚山楂石。1 .2　治疗方法术前以 1 0ｇ/Ｌ地卡因喷洒咽部 ,病人左侧卧位 ,胃镜缓慢进入咽部后 ,常规检查食管、胃…     

经电子胃镜取出上消化道异物87例治疗分析

目的 探讨电子胃镜取出上消化道异物的方法和时机。方法 采用富士能200、奥林巴斯240．V70电子胃镜厦其取异物配件治疗上消化道异物87例。结果 异物位于食管61例，胃3例，十二指肠23例。异物种类主要为鱼刺、鸡骨、鸭骨、寄生虫、金属钥匙、胃石、假牙等。内镜治疗均获成功”结论 上消化道异物在除外自然排出的可能性后应立即行内镜取出，成功率高，无严重并发症。     

经内镜取出上消化道异物5例

1990年5月至1991年12月,用GIF—K_2型和GIF—XQ_20型纤维胃镜取出上消化道异物5例,报告如下.1 临床资料5例中男4例,女1例.年龄最小者3岁,最大者63岁.食管异物4例,胃内异物1例.吞咽异物后来诊时间最短12小时,最长7天.主要症状吞咽困难、吞咽时疼痛、呕吐和上腹痛.取出异物分别为:直径0.1cm长3cm的铁丝、3.5cm×O.7cm×0.3cm的带有软骨的熟猪耳肉、直径2cm厚0.2cm的有机玻璃钮扣、直径0.2cm长2.5cm的鸡骨和3.5cm×2cm×1.5cm的桃核一个.2 方法 2%利多卡因咽部喷雾麻醉后,     

上消化道异物35例内镜诊治体会

上消化道异物是临床上常见的急症,迅捷简便的诊疗方法当属内镜介入诊疗。2000年1月~2006年5月,我院在电子胃镜直视下诊治35例上消化道异物,取得满意效果。现报告如下。资料与方法1.一般资料本组35例,男20例,女15例,年龄8~76岁,平均42岁。误吞异物者34例,在押犯人故意吞服者1例。病程最短者为1小时,最长者为3周。2.异物种类与部位异物按其来源分类[1]:外源性异物32例,异物数量共38件,分别为鱼刺6例,鸡骨5例,鸭骨4例,猪骨2例,铁丝1例,纽扣电池1例,果核1例,肉块2例,食物团10例。内源性异物3例,异物数量共3件,分别为胃石2例,蛔虫1例。异物存留部…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.