雷贝拉唑与兰索拉唑三联疗法治疗幽门螺杆菌阳性消化性溃疡疗效比较

目的:比较雷贝拉唑三联疗法与兰索拉唑三联疗法治疗幽门螺杆菌阳性消化性溃疡的疗效。方法:将幽门螺杆菌阳性的消化性溃疡83例分为两组:治疗组(雷贝拉唑三联疗法组)41例,以雷贝拉唑10mg,阿莫西林1000mg及甲硝唑400mg每日2次口服,治疗1周后单独服用雷贝拉唑10mg,连服7d;对照组(兰索拉唑三联疗法组)42例:以兰索拉唑30mg,阿莫西林1000mg及甲硝唑400mg,每日2次口服,治疗1周后单独服用兰索拉唑30mg,连服7d。治疗期间每周门诊随诊,记录临床症状改善情况,用药结束1个月后复查胃镜并检测幽门螺杆菌结果。结果:治疗组和对照组1d的临床症状缓解率分别为80%、60%,差异有统计学意义(P<0.05);1周后症状缓解率均为98%。治疗组和对照组的溃疡愈合率分别为93%和76%,差异有统计学意义(P<0.05);治疗组和对照组的总有效率分别为98%和96%,差异无统计学意义(P>0.05)。治疗组和对照组的幽门螺杆菌根除率分别85%和81%,差异无统计学意义(P>0.05)。结论:两组方案均能有效治疗消化性溃疡和缓解临床症状,并能有效地根除幽门螺杆菌。但雷贝拉唑三联疗法在改善临床症状和促进溃疡愈合方面优于兰索拉唑三联疗法。     

顽固性下颌磨牙根尖周炎患者的治疗和护理讨论

目的治疗顽固性下颌磨牙根尖周炎。并尽量减少对牙周膜的机械性损伤。方法采用下牙槽神经阻滞麻醉,并配合局部麻醉。拔牙钳的尖置放于釉牙骨质界以上,采用颊舌向摆动的方式将患牙拔下。在不断滴有生理盐水的条件下,立即用高速车针磨除患牙根尖2￣3mm的牙体组织,根管内3￣5mm深的充填物要用圆钻将其清除,再用牙胶尖和氢氧化钙糊剂充填。将患牙再植入牙槽窝之前,务必用生理盐水将牙槽窝冲洗干净,要求严格控制在15分钟内完成再植,并尽量减少对牙周膜的机械性损伤。再植牙齿一般不需要夹板固定,必要时可采用缝线缝合固定。结果我们选择的5例患者,术后随访1￣2年,1例患者再植失败,4例患者再植成功。结论特异性再植术治疗顽固性下颌磨牙根尖周炎疗效理想,而且较易掌握。     

带浅静脉干逆行皮瓣早期微血管构筑变化的体视学研究

目的 探讨带浅静脉干的逆行皮瓣早期微血管构筑变化的特点以供临床实践参考。方法 应用生物体视学技术测量带浅静脉干皮瓣微血管体积密度，结合组织学观察，与不带静脉干皮瓣作对照比较。结果 带浅静脉干皮瓣组微血管密度整体水平高于不带静脉干皮瓣组（P〈0．05）。结论 浅静脉干的存在有利于皮瓣的血管化进程，保留浅静脉干对皮瓣成活有利。     

银锌霜治疗压疮的疗效观察

目的行银锌霜治疗压疮的疗效观察。方法采用凯新银锌霜治压疮,并与其他疗法作对照研究。结果银锌霜治疗压疮效果比对照组好,两组差异具有显著性(P=0.01)。结论银锌霜治疗压疮作用快,治愈率高。*     

Resection of hepatocellular carcinoma with tumor thrombus in the major vasculature. A European case-control series

Tumor thrombus in major vasculature is a frequent finding with a poor long-term prognosis in patients with hepatocellular carcinoma (HCC). The utility of surgical resection is still controversial. This study compared morbidity and survival after resection for HCC with and without tumor thrombus. Data of 108 patients who underwent major hepatic resection for HCC were prospectively recorded. Patients were divided into two groups. The venous thrombectomy (VT) group included 26 patients who had HCC with tumor thrombus in the portal or hepatic veins. The matched control group included 82 patients who had HCC without tumor thrombus. Surgical technique, early outcome, and late survival were analyzed in each group. Multivariate analysis was performed to assess the prognostic value of this feature. Surgical technique was comparable in the VT and control group with regard to extent of hepatectomy, procedure duration, and transfusion requirements. Early postoperative outcome was also comparable. Actuarial survival at 1, 3, and 5 years was 38%, 20%, and 13%, respectively, in the VT group (median: 9 months) versus 74%, 56%, and 33%, respectively, in the control group (median: 41 months). In the subgroup of patients with tumor thrombus limited to the portal vein, actuarial survival at 1, 3, and 5 years was 50%, 26%, and 17%, respectively, (median: 12 months) and two patients lived longer than 5 years. Multivariate analysis showed that incomplete resection, alphafetoprotein level greater than 100 N, more than two tumor nodules, and tumor thrombus in major vasculature were independent factors of poor prognosis. Survival after resection for HCC with tumor thrombus in the major vasculature is poorer than after resection for HCC without tumor thrombus. However, an aggressive surgical strategy can provide significant survival with comparable morbidity in selected cases, that is, tumor thrombus located in the portal vein only and expected complete resection of the lesions.     

Laparoscopic subtotal gastric resection for chronic gastric ulcers.

OBJECTIVES: We analyzed our experience with the laparoscopic approach for treating benign gastric lesions. METHODS: Between June 1998 and June 2002, we performed 18 gastric resections with the laparoscopic approach for 7 pyloric stenoses, 8 recurrent duodenal ulcers, and 3 chronic gastric ulcers. RESULTS: In our series, we performed Billroth II laparoscopic distal gastrectomy with no morbidity and mortality. CONCLUSIONS: Billroth II laparoscopic distal gastrectomy is safe in cases of benign gastric or duodenal lesions.     

Differential diagnosis of leg ulcers

In Germany about 0.7 % of the adult population have a chronic leg ulcer. Although chronic venous insufficiency accounts for at least 80 % of all chronic leg ulcers, knowledge of the relevant differential diagnostic considerations is of crucial importance, in particular for patients who are refractory to therapy. In addition to vascular disease, other causes include neuropathic, metabolic, hematologic and exogenous factors as well as neoplasias, infections, drugs, genetic defects and some primary skin disorders. For the long‐term successful treatment of patients with chronic leg ulcers, it is necessary to identify all relevant factors, in order to enable a pathogenesis‐oriented, interdisciplinary therapeutic approach.     

IS THERE A SPECIFIC LINKAGE BETWEEN OBSTRUCTIVE SLEEP APNEA SYNDROME AND GASTROESOPHAGEAL REFLUX DISEASE?

Obstructive sleep apnea syndrome (OSAS) is a common condition characterized by repetitive sleep‐induced collapse of the upper airways. It is associated with increased risk for hypertension, ischemic heart disease, cerebral stroke, and traffic accidents. In contrast, gastroesophageal reflux disease (GERD) is a very common disorder defined as various symptoms or esophageal mucosal damage generated by the abnormal reflux of gastric contents into the esophagus. Patients with OSAS have been reported to have a high prevalence of gastroesophageal reflux (GER) symptoms. The increase of transdiaphragmatic pressure in parallel with the large negative intrathoracic pressure produced during apnea events may directly lead to GER. In addition, some studies have demonstrated improvement in GERD with the application of continuous positive airway pressure, most consistently effective treatment for OSAS. However, GER dose not occur with every apnea. Moreover, the common conditions observed in patients with OSAS, including obesity or alcohol ingestion, are also predisposing factors for GER. A more recent investigation in over 1000 subjects failed to show a causal link between both diseases. Thus, the potential relationship between OSAS and GERD remains controversial. Inconsistencies in definitions of both diseases or sampling biases may contribute to the confusing results.     

Basic fibroblast growth factor and epidermal growth factor reverse impaired ulcer healing of the rabbit oral mucosa

BACKGROUND: The therapies for refractory ulcers on the oral mucosa are symptomatic and very unsatisfactory. We hypothesized that application of growth factors might be able to achieve successful remission of the lesion. We evaluated the effects of systemic administration and topical application of epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) on impaired wound healing of ulcers in the rabbit gingiva. METHODS: Almost uniform round ulcers could be created on the gingiva of the rabbits by chemical injury with acetic acid. When the submandibular glands were removed or i.v. injection of cisplatin (CDDP) and peplomycin sulfate was performed before ulcer formation, healing of the ulcers took longer than in untreated rabbits. To ascertain whether or not human EGF and bFGF affect rabbit cells, we first examined the effects of EGF and bFGF on the proliferation of the cells derived from rabbit gingiva. We then applied EGF or bFGF in these impaired healing models. RESULTS: EGF and bFGF promoted proliferation of the fibroblasts, and EGF also promoted proliferation of the keratinocytes isolated from gingival tissue of rabbits in vitro. Systemic injections of EGF and bFGF in rabbits, which had their submandibular glands removed, and topical application of bFGF accelerated healing of ulcers created in rabbits injected with CDDP and peplomycin sulfate. The ability of bFGF to promote the healing of ulcers was much greater than that of EGF. CONCLUSION: Basic FGF may be effective for refractory oral mucosal lesions.     

腹内高压对门静脉压、中心静脉压影响的实验研究

目的研究腹内压升高对大鼠中心静脉压和门静脉压的影响。方法将20只成年雄性SD大鼠分别通过颈静脉插管、穿刺门静脉主干法来测定中心静脉压和门静脉压，运用氮气气腹法制作大鼠腹内高压动物模型。建立气腹后分别在0、5、10、15、20、25、30、35、40、45mmHg压力值下测得中心静脉压和门静脉压。结果中心静脉压和腹内压之间的直线回归方程为Y=2．824＋0．045X，相关系数r=0．984（P〈0．01）；门静脉压和腹内压之间的直线回归方程为Y=8．887＋0．939X，相关系数r=0．998（P〈0．01）。结论腹内压与中心静脉压和门静脉压有很好的相关性，可以根据腹内压监测中心静脉压和门静脉压的变化。