低位十二指肠穿透溃疡大出血治疗体会

目的探讨28例低住十二指肠穿透溃疡大出血的手术经验。方法降部前壁穿透溃疡大出血2例，行渍疡切除，T字型缝合法；球部后壁15例行改良NISSEN氏法；降部前壁并球部后壁5例联合上述两法；球部后壁穿孔2例，行Lahey氏法；球部前壁严重疤痕并后壁巨大穿透溃疡大出血2例，行十二指肠残端一空肠Roux-y吻合法。结果均手术治愈，无严重并发症。结论术中彻底探查胃十二指肠，选择适当术式，开放式处理残端，可提高治愈率，减少并发症。     

健胃愈疡颗粒剂对大鼠胃溃疡的影响及VEGF和PDGF表达的变化

目的研究健胃愈疡(Jianweiyuyan，JWYY)颗粒对溃疡的影响，并探讨其机制。方法以Okabe改良法复制大鼠实验性胃溃疡，观察其对溃疡指数和溃疡组织学的影响，并用免疫组化法观察血管内皮生长因子(VEGF)、血小板源性生长因子(PDCF)表达的变化。结果JWYY颗粒能提高VEGF、PDGF表达，明显降低溃疡指数，增加黏膜厚度，促进溃疡愈合。结论JWYY颗粒通过提高VEGF、PDGF表达，提高溃疡愈合质量，这可能是其促进渍疡愈合的机制之一。     

Effect of mucosal suture on the healing of mucosal defect in laparoscopic intragastric surgery

Background. The efficacy of mucosal suturing for the healing of a mucosal defect in laparoscopic intragastric surgery (LIGS) for gastric lesions is not yet known. Methods. We prospectively studied ten patients who underwent mucosal resection by LIGS for gastric tumors: four patients with early gastric cancer and six with gastric adenoma. Patients were randomly divided into two groups: group I (n = 5); patients who underwent mucosal resection by LIGS with mucosal defect suturing and group II (n = 5); patients who underwent mucosal resection by LIGS without mucosal defect suturing. We performed endoscopy on day 10, and 1 month, 2 months, and 3 months after the operation to observe the healing process of the mucosal defect. The ulcer stage by endoscopy was classified as active, healing, or scarring according to the classification of Sakita and colleagues. Patients were given an H₂-blocker daily until the mucosal defect improved to the scarring stage. Results. There were no significant differences in sex, age, tumor location, size of mucosal resection, or the incidence of Helicobacter pylori infection between groups I and II. The ulcer stages in group I were significantly lower than those in group II on day 10, and 1 month, 2 months, and 3 months postoperation. The medication cost (H2-blocker) in group I was significantly lower than that in group II. Conclusion. Mucosal defect suturing after mucosal resection by LIGS promotes more rapid healing of mucosal defects and reduces drug costs for patients. Received: September 5, 2002 / Accepted: January 9, 2003 RID="*" ID="*" Offprint requests to: T. Yumiba, Department of Surgery, Osaka Kosei-Nenkin Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka 553-0003, Japan     

基于PINK1/Parkin信号通路探讨丹黄散在糖尿病小鼠溃疡创面愈合中的作用

目的:基于同源性磷酸酶张力蛋白诱导激酶1(PINK1)/帕金森蛋白(Parkin)信号通路探讨丹黄散在糖尿病小鼠溃疡创面愈合中的作用。方法:选取18只SPF级雄性db/db小鼠,随机分为模型组、生长因子组、丹黄散组,每组6只,另选取6只SPF级雄性db/m小鼠作为空白组,各组小鼠均构建糖尿病溃疡模型。空白组与模型组小鼠以0.9%氯化钠溶液清创并用无菌纱布覆盖创面,生长因子组与丹黄散组小鼠在其基础上分别外敷表皮生长因子凝胶和丹黄散。观察比较各组小鼠溃疡创面愈合情况及PINK1/Parkin信号通路关键蛋白表达水平。结果:模型组第7、14、21天的创面愈合率明显低于丹黄散组、生长因子组(均P<0.05);HE染色和电镜观察创面组织,相较于模型组,生长因子组、丹黄散组创面肉芽组织病理改变明显减轻,大量成纤维细胞增生,致密分布,出现少量新生毛细血管,PINK1、Pakin和LC3-Ⅱ/Ⅰ蛋白表达水平均明显增加(均P<0.05)。结论:丹黄散可促进糖尿病小鼠溃疡创面愈合,可能通过调节PINK1/Pakrin信号通路进而调控线粒体自噬,保护线粒体功能,促进血管新生和肉芽组织生长,加快创...     

中西医结合治疗对幽门螺杆菌感染性胃溃疡患者临床疗效、胃黏膜的影响研究

目的:对中西医结合治疗对幽门螺杆菌感染性胃溃疡患者临床疗效、胃黏膜的影响进行研究。方法:选我院50例幽门螺杆菌感染性胃溃疡患者为对象,随机分成2组,对照组常规治疗,试验组中西医结合,对两组结果进行比较。结果:治疗后,试验组患者溃疡愈合率、幽门螺杆菌清除率与对照组相比显著偏高,P<0.05;试验组患者的腺体密度、胃黏膜厚度与活动性炎症浸润以及慢性炎症细胞浸润得分与对照组相比显著偏优,P<0.05。结论:对于幽门螺杆菌感染性的胃溃疡患者来说,实施中西医结合可以显著提高患者的疗效,改善病人胃黏膜的形态。     

Extranodal NK/T Cell Lymphoma,Nasal Type with Palatal Involvement: A Rare Case Report and Literature Review

T-cell lymphomas are infrequently encountered in the head and neck area, with the most common subtype being Extranodal NK/T cell lymphoma, nasal type (ENKTL-NT). ENKTL-NT shows a predilection for midline facial structures presenting with ulcerative destructive lesions, whereas palatal involvement is one of the most prominent signs from the oral cavity. Herein, we describe a case of a 76-year-old Greek man with nasal obstruction and an extensive painful necrotic ulcer with ragged borders on the left distal portion of the soft palate and palatine tonsil of 4-months duration. After an initial non-diagnostic biopsy from the nasopharynx, a second incisional biopsy from the palatal lesions was performed. Histopathology was suggestive of an angiocentric lymphoproliferative neoplasm and immunohistochemical examination and in situ hybridization for EBV RNA led to a final diagnosis of ENKTL-NT. The patient was placed under combined chemotherapy and radiotherapy and no recurrence has been noted. Additionally, a retrospective review of the cases in the English literature with an established diagnosis of ENTKL-NT between 2000 and 2019, based on the latest WHO classification of Head and Neck tumors, is performed.     

消化性溃疡与螺杆菌关系的临床病理研究

目的：探讨消化性溃疡（PU)与胃内螺杆菌感染的关系。方法：以Warthin-Starry银染色和石碳酸－碱性品红染色,高倍镜和油镜下观察螺杆菌感染状况,然后与临床对比分析。结果：①十二指肠溃疡（DU）89例,胃溃疡（GU）14例,胃十二指肠复合溃疡（GDU）7例。79例幽门螺杆菌（Hp）阳性;16例海尔曼螺杆菌（Hh）阳性;Hp与Hh混合感染13例（DU占10例）;②PU病变重：溃疡较大,双溃疡,多溃疡和GDU比例大,并发穿孔出血比率高;③PU伴随之慢性胃炎病变重,其重度炎症占77.27％。慢性萎缩性胃炎（CAG）及肠上皮化相对较少。结论：PU与Hp、Hh的感染或混合感染有直接或间接的关系,值得深入探讨。     

Scopolamine and amphetamine effects on discrimination: Interaction with stimulus control

Forty rats were housed in standard activity wheel cages and fed for only 1 hr per day. The animals were equally divided into 4 groups that received either saline, 12.5 mg/kg, 25.0 mg/kg or 50.0 mg/kg of metiamide, an H₂ receptor antagonist, 3 times a day. All animals died within 11 days and all demonstrated significant gastric lesions in the glandular fundus of the stomach. The 50.0 mg/kg dosage group, however, demonstrated significantly fewer ulcers than the saline animals and the lesions that did occur were significantly smaller than those noted in the control animals. Several hypotheses were offered to explain these results which took into account metiamide's effects on gastric secretion and motor activity. It was suggested that secretion of acid may be an important contributing factor in the formation of gastric ulcers in animals subjected to the activity-stress procedure.     

超声造影对2型糖尿病患者颈动脉低回声斑块稳定性的初步研究

目的:应用超声造影技术初步评价2型糖尿病患者颈动脉低回声斑块形成溃疡及新生血管的情况.方法:在二维超声基础上运用超声造影技术分别对30例2型糖尿病患者和20例非糖尿病患者颈动脉低回声斑块进行检测,动态实时观察斑块内有无溃疡及新生血管.结果:颈动脉造影对颈动脉斑块的检出率高于二维超声,但二者比较差异无统计学意义;经颈动脉造影检查,糖尿病组30例患者共发现41个低回声斑块,其中16个斑块内发现溃疡,30个发现新生血管,5个发现溃疡合并新生血管,非糖尿病组20例患者共发现29个低回声斑块,17个斑块内发现溃疡,12个发现新生血管,未发现溃疡合并新生血管,经统计学分析两组病例发现溃疡的斑块数差异无统计学意义,发现新生血管的斑块数差异有统计学意义.结论: 超声造影可以很好地观察颈动脉低回声斑块内有无溃疡及新生血管,进一步评价斑块的稳定性;2型糖尿病患者颈动脉低回声斑块内新生血管更丰富.     

Viability of permanent PMMA spacer with combined free fasciocutaneous tissue transfer for failed charcot reconstruction: A 38 month prospective case report

IntroductionCharcot Neuroarthropathy is a complex lower extremity pathology which predisposes the afflicted limb to ulcerations, osteomyelitis, and risk of major amputation. Charcot Neuroarthropathy often requires osseous reconstruction, which can be complicated with osteomyelitis and hardware infection. When soft tissue and osseous deficits must be concomitantly addressed, the use of PMMA spacers can be combined with free tissue transfers.Presentation of case71 year old Caucasian male with Diabetic Charcot Neuroarthopathy underwent osseous reconstruction with internal hardware. The surgical site was complicated by acute infection, osteomyelitis, exposed hardware requiring removal, and multiple surgical débridement. The degree of soft tissue and osseous deficit post-débridement required complex reconstruction.DiscussionThe osseous deficit was addressed with the use of a permanent PMMA cement spacer. The soft tissue deficit was reconstructed with a free tissue transfer. This case report demonstrates the long term viability and utility of the use of permanent cement spacers when combined with free tissue transfer for closure of complex diabetic foot wounds. This case is an example of a multidisciplinary team approach to limb salvage with successful long term outcome; a plantigrade stable functional foot in an ambulatory highly active patient. Follow up time since initial intervention was 38 months.ConclusionThe use of a permanent PMMA cement spacer does not preclude free tissue transfer in complex host lower extremity reconstruction. A multidisciplinary team approach is a vital component to successful salvage outcomes.