老年胃癌70例手术治疗体会

目的 探讨老年患者胃癌的临床特点与手术方式.方法 回顾性分析我院2002年1月～2008年12月手术治疗老年胃癌70例患者的临床资料.结果 术后并发症共发生20例,其中肺部感染6例,切口感染3例,腹腔感染2例,胸腔积液2例,心律失常2例,心功能不全1例;吻合口瘿2例,消化道应激性溃疡出血1例,肿瘤晚期衰竭死亡1例,其余均治愈或好转出院.结论 老年胃癌手术治疗在确定合理治疗方案的同时,处理好伴有疾病和降低并发症是提高治愈或好转率的关键之一.     

70岁以上食管贲门癌手术治疗103例分析

目的总结70岁以上老年食管贲门癌患者手术治疗的临床经验。方法回顾103例70岁以上老年食管贲门癌患者手术治疗临床资料，总结其特点，统计其手术结果并加以分析。结果手术成功切除94例，全部机械吻合。其中经腹切除贲门癌12例。9例术中无法切除肿瘤，采用了术中安放食管支架3例，胃造瘘2例，另4例（系食管癌）术后采用放疗。术中无死亡病例，术后6天死亡1例，术后1月3月各死亡1例。3月至12月死亡9例。术后肺部感染11例，心律失常18例，消化功能紊乱36例。结论70岁以上老年食管贲门癌患者手术治疗机会大，手术成功切除率91．26％，但术后并发症明显高于60岁以下患者组。手术治疗成功的关键在于掌握好手术适应症，必须对患者全身状况进行细致的评估，尤其是以心肺功能为主的评估。术前治疗伴发症。提高患者耐手术的能力，尽可能缩短手术麻醉时间，减少手术并发症，及时发现和处理并发症，常规术后ICU监护，强有力的支持和抗感染治疗等均是必要的。     

腹腔镜下治疗胃十二指肠疾病42例临床分析

目的探讨腹腔镜下手术治疗胃十二：指肠疾病的临床价值、手术方法、适应证及优缺点。方法腹腔镜手术组为胃十二指肠疾病患者42例，其中胃壁良性肿瘤切除术14例、胃十二指肠溃疡穿孔修补术11例、胃大部切除术10例、高选择性迷走神经切断术7例，应用腹腔镜技术行手术治疗。对照组为不经过腹腔镜进行同类型手术治疗的患者，每种类型手术患者10例。统计手术时间、住院时间、术中出血量和并发症。结果腹腔镜手术组肿瘤切除、穿孔修补、胃大部切除和迷走神经切断术的手术时间、术中出血量、住院时间和并发症等指标，均显著优于同类型手术的对照组。结论腹腔镜下治疗胃十二指肠疾病具有创伤小、手术时间短、术后恢复快及术后并发症少的特点。胃壁良性肿瘤切除、胃十二指肠溃疡穿孔修补、胃大部切除、高选迷走神经切断均是腹腔镜手术治疗的适应证。     

老年急腹症340例诊断与治疗

目的探讨常见老年外科急腹症的临床特点及诊断与治疗。方法对340例老年急腹症病例资料进行回顾性分析,统计患者术前误诊情况、合并疾病、术后并发症及死亡原因等情况,并进行相关诊治分析。结果手术治疗285例,非手术治疗55例。323例治愈,17例死亡。结论老年外科急腹症的特点是发病急、发展迅速、多合并不同程度的内科疾病,临床表现不典型,容易导致误诊,早期诊断,与内科协作处理并发症,选择合适的手术方法和麻醉方式,掌握好手术时机,能减少老年急腹症患者的术后并发症和死亡率。     

胃大部切除术后残胃幽门螺杆菌感染的临床研究

目的探讨胃大部切除术后残胃病变与幽门螺杆菌(Hp)感染的关系。方法采用快速尿素酶试验、组织切片W arth in-Starry银染及尿素呼气试验检测682例残胃病患者Hp感染情况,并进行流行病学分析。结果682例残胃病患者Hp感染检出率为27.42%,与年龄、性别以及术后时间无关;B illroth I式术后残胃Hp检出率(40.07%)明显高于B illroth II式术后残胃Hp检出率(17.37%),而伴有胆汁返流的残胃Hp感染阳性率(7.98%)明显低于不伴胆汁返流的残胃阳性率(33.53%)。同时,因溃疡、穿孔、出血行手术的残胃Hp检出率(47.88%)高于因胃癌手术的检出率(22.66%);不同病理学残胃中,残胃溃疡和残胃癌的Hp感染率明显高于慢性残胃炎及吻合口炎的Hp感染率。结论胃大部切除术后残胃病变与Hp感染密切相关,尤其是残胃癌,应及早进行Hp治疗,可减轻残胃病变,减少残胃癌的发生。     

阑尾切除手术后切口感染的防治体会

急性阑尾炎是常见的外科急腹症。大多数需要手术治疗,阑尾切除手术是外科医生的最基本手术,而该手术最常见的并发症是切口感染,居所有腹腔手术切口感染的首位,占术后并发症总发生率的45.1%～83.8%。如何防治切口感染,是普外科医师值得重视的问题,它直接关系到手术治疗的效果。其发生的原因与疾病本身的特点有关，更与围手术期的处理方法是否恰当及手术操作规范与否有关，减少阑尾炎术后切口感染，关键是预防。我们通过采取以下综合防治措施，明显降低了各型阑尾炎的手术切口感染率。     

70岁以上患者颈段及胸上段食管癌的外科治疗

目的探讨70岁以上患者颈段及胸上段食管癌的外科治疗。方法回顾性分析68例70岁以上颈段及胸上段食管癌患者的临床资料,全组患者均经左胸左颈二切口食管癌切除局部淋巴结清扫,食管-胃颈部吻合术。结果 68例患者均顺利完成手术切除食管肿瘤,死亡3例,其余病例恢复良好出院,术后主要并发症为心、肺并发症及吻合口瘘。结论高龄高位食管癌手术难度大、术后并发症多,经左胸左颈二切口颈部吻合手术方式能缩短手术时间,减少术后并发症,提高手术疗效。     

胃癌术后并发胰腺炎的诊治体会

目的 探讨分析胃癌术后并发胰腺炎的诊断与治疗.方法 回顾性分析我院2006年1月至2012年1月收治的31例患者胃癌术后诊断为急性胰腺炎,分析所有患者的治疗经过以及诊断、治疗过程.结果 胃癌D2根治术患者的急性胰腺炎和SAP发生率分别为2.65％和0.66％,均明显低于D3根治术患者的12.58％和4.64％,而31例并发急性胰腺炎患者保守治疗的总有效率为95.24％,明显高于对照组的60.00％,D3术式下毕Ⅱ切除和全胃切除急性胰腺炎发生率均高于毕Ⅰ切除和近端胃切除,差异均具有统计学意义(P＜0.05).结论 临床胃癌术后并发胰腺炎的诊断需要与患者手术损伤程度相结合,密切观察患者各项生命体征从而做出及时诊断,治疗上以保守治疗为主.     

高龄胃癌合并2型糖尿病患者的围手术处理

目的探讨高龄胃癌合并2型糖尿病患者的围手术处理。方法对2000-2010年间108例高龄胃癌合并糖尿病患者围手术处理情况进行回顾性分析。结果 108例病人均作胃癌限期手术,术后并发症发生率为36.1%,其中切口感染19例（17.6%）,肺部感染12例（11.1%）,吻合口漏4例（3.7%）,泌尿系感染2例（1.9%）,高渗性昏迷1例（0.9%）,死亡1例（0.9%）。术后患者平均住院时间为19d。结论控制血糖和选择合理的术式、手术时机,高龄胃癌并糖尿病患者可顺利度过围手术期,并取得良好的手术疗效。     

胃癌急性穿孔的预后研究

目的 探讨胃癌急性穿孔的预后影响因素。方法 选择2013年1月~2018年1月我院共收治的胃癌急性穿孔患者89例,其中行急诊手术切除38例,同时期行分期手术切除51例。收集急诊手术切除与分期手术切除治疗胃癌穿孔患者的临床资料,比较手术切除率、并发症及术后生存率,采用Kaplan-Meier法计算总体生存时间,作Log-rank检验。结果 急诊手术切除与分期手术切除患者腹腔积液、病程、ALB水平、WBC水平、RBC、HGB、术中输血浆比较,差异有统计学意义（P＜0.05）;急诊手术切除与分期手术切除患者术后1,2,3和5年生存率比较,差异无统计学意义（P＜0.05）;急诊胃切除患者中位总体生存时间26.7个月,分期手术切除患者中位总体生存时间31.6个月,差异无统计学意义（P＜0.05）;年龄、ALB水平、肿瘤穿孔部位、肿瘤直径、UICC/TNM分期、淋巴结转移等6个因素与总体生存相关（P＜0.05）。结论 急诊胃切除术是治疗胃癌急性穿孔的可行方法,年龄、ALB水平、肿瘤穿孔部位、肿瘤直径、UICC/ TNM分期、淋巴结转移6个因素是胃癌穿孔急诊胃切除术后并发症及生存影响因素。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

Class II HLA in Georgia Caucasus Tbilisi Georgians and their Mediterranean ancestry: The Usko Mediterranean languages

Georgia (or Sakartvelo in its own language) is a South Caucasus Mts. country with its easternmost part is enigmatically named Iberia, like the Iberian Peninsula, which may refer to rivers “Kura” and “Ebro” or their valleys respectively. Most of their inhabitants speak Georgian which is included within Dene-Caucasian group and Usko-Mediterranean subgroup of languages. The latter includes Basque, Berber, ancient Iberian-Tartessian, Etruscan, Hittite, Minoan Lineal A and others. In the present paper, HLA class II -DRB1 and -DQB1 alleles has been studied and extended haplotypes calculated. Most frequent haplotypes are also of Mediterranean origin (i. e.: (A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*51)-DRB1*13:01-DQB1*06:03, or (A*24-B*35)-DRB1*01:01-DQB1*05:01) and DA genetic distances show that closest world populations to Georgians are Mediterraneans. Georgians also show common extended haplotypes ((A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*13)-DRB1*07:01-DQB1*02:01 and (A*03-B*35)-DRB1*11:01-DQB1*03:01) with Svan people, a secluded population in North Georgia mountains. We can conclude that Georgians belong to a very old Mediterranean substratum according to both linguistics (Usko Mediterranean languages) and HLA genetics.     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Environmental risk factors and their role in the management of atopic dermatitis

Introduction: The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors.

Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD.

Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.     

Functional role of fertility α2

Fertility α₂-microglobulin is one of the main proteins expressed between the late lutein phase of the menstrual cycle and the first gestation trimester. It is produced by endometrial secretory glandular epithelium and decidual membrane. It is believed to be involved in the preparation to gestation, conception, normal development of the fetoplacental system, and initiation of labor. The immunomodulating, effect of fertility α₂-microglobulin and its possible involvement in the regulation of fertilization by blocking the spermatozoon reaction with the ovocyte lucid membrane were demonstratedin vitro. The data of structural analysis (appurtenance to lipocalines and unique pattern of N-glycosylation) and analysis of the spatial and temporal parameters of the expression in connection with other events in the organism within the same system of coordinates propated us to investigate the probability of realization of other, so far unknown functions of α₂-microglobulin. The probable mechanisms of realization of the immunomodulating function are analyzed. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 126, No. 10, pp. 364–373, October 1998