CT诊断胃肠道藏毒36例

目前毒品包装工艺不断改进,胃肠道藏毒成为特殊的毒品转运方式.本文讨论CT诊断胃肠道藏毒的价值.     

肠道粘膜相关淋巴组织淋巴瘤临床病理研究

目的探讨肠道粘膜相关淋巴组织淋巴瘤(Mucosa-assoc iated lymphoid tissue lymphom a,MAL-Tom a)的临床病理特征。方法对30例肠道MALTom a进行临床病理观察,采用S-P免疫组化法对其免疫表型进行分析。结果肠道MALTom a多见于老年人,无性别差异。好发于小肠,以回肠多见(46.6%)。以低度恶性多见(24例),累及淋巴结比率较低(16.7%),而高度恶性者少见(6例),累及淋巴结比率高(66.7%),二者间存在统计学差异,(P<0.05)。肠道MALTom a大体呈息肉型、溃疡型和浸润型,以息肉型多见。组织学表现仿效正常的粘膜相关淋巴组织的结构,可见淋巴滤泡,形态上类似滤泡中心细胞,常伴浆细胞分化,肿瘤细胞有亲上皮性,常侵入上皮形成特殊的淋巴上皮病变。免疫组化染色显示为单克隆B淋巴细胞来源。结论肠道MALTom a以小肠多发,常为低度恶性,组织学上具有淋巴滤泡、浆细胞分化以及淋巴上皮病变等特征性病理改变。     

Small bowel enteroclysis survey

A survey questionnaire was sent to 125 radiology programs to determine the frequency and indications for the use of small bowel enteroclysis. Sixty-seven of the 84 respondents perform small bowel enteroclysis while 17 do not. The 3 most common indications for enteroclysis are detection of unexplained gastrointestinal bleeding, partial small bowel obstruction, and Crohn's disease. We conclude that although small bowel enteroclysis is a well-established examination, there are wide differences in the frequency with which it is performed, the techniques of examination, and indications for its use.     

Rectosigmoid sphincter of O'Beirne

In the early 19th century, James O'Beirne proposed that a physiologically important sphincter existed at the rectosigmoid junction. Interest in the rectosigmoid junction had been stirred by a common affliction of the time: spasmodic constriction of the rectum. It was believed that many patients suffered from chronic constipation because of rectosigmoid spasms. O'Beirne proposed that a sphincter at the rectosigmoid junction governed the passage of stool from the sigmoid into the rectum. Further, he maintained that spasmodic constriction of the rectum resulted from dysfunction of this rectosigmoid sphincter. His views, however, conflicted with those of such contemporaries as Houston, who emphasized the role of rectal valves in producing spasmodic constriction. Anatomic studies in the early 20th century found at least a rudimentary sphincter at the rectosigmoid junction in 40 percent of the normal population. Motility studies in the last 35 years have demonstrated unique intraluminal pressure patterns as well as the propagation of retroperistatic waves in this area. The rectosigmoid in patients with constipation shows an increased activity, as if this area is causing a physiologic obstruction to the passage of stool into the rectum. In contrast, the rectosigmoid in patients with diarrhea demonstrates markedly decreased activity, thereby providing unobstructed access of the feces to the rectum. These studies support O'Beirne's hypothesis that a sphincter governs the passage of stool from the sigmoid colon into the rectum.     

《本草纲目》鲊答疑考

载于《本草纲目》的“鮓答”究为何物。从民族医药学文献考证,中药鮓答应是肠胃道结石,不是肝胆结石,也不是藏药“鮓石”。鮓石是指鱼脑石。     

幼鼠肠缺血再灌注损伤下免疫器官凋亡的分子病理学研究

目的 探讨幼鼠肠缺血再灌注（I／R）下免疫器官凋亡的发生及分子病理学机制。方法 32只雄性Wistar大白鼠随机分成4组：生理对照组、麻醉组、假手术组、缺血再灌注组。用电镜、TUNEL法（TdT介导的dUTP末端缺口标记是一种检查细胞凋亡的方法，一般采用半定量方式计算结果。检测免疫器官凋亡的发生；原位杂交方法检测Fas(凋亡因子）/Fas-LmRNA的表达。结果 脾脏主要在红髓内存在凋亡，淋巴结主要在髓窦内存在凋亡，凋亡指数从1－4组逐渐升高，除1、2组外，各组差异均有显著性意义。胸腺内存在Fas/Fas-L的表达（Fas-L是Fas的配体，Fas与Fas-L结合，可以引起有Fas表达的细胞凋亡。）但表达量极少；脾脏Fas表达明显高于Fas-L；淋巴结Fas-L表达明显高于Fas，表达量从1－4组逐渐升高，除1、2组外，各组差异增有显著性意义。结论 ①在幼鼠肠I／R早期，脾主要以增加Fas的表达引发凋亡，肠系膜淋巴结主要以增加Fas-L的表达引发凋亡；②在幼鼠肠I／R早期，可能通过影响外周免疫器官巨噬细胞及淋巴细胞的凋亡，影响免疫功能状态。     

Fatal intestinal ischemia after laparoscopic correction of incisional hernia.

BACKGROUND AND OBJECTIVES: Intestinal ischemia is a very rare complication of laparoscopic procedures. In this report, we describe the first case of fatal large bowel ischemia in the aftermath of laparoscopic incisional hernia repair. METHODS: A literature search using PubMed was performed to identify all published cases of intestinal ischemia following laparoscopic procedures. RESULTS: Our search revealed 13 cases of intestinal ischemia following various laparoscopic procedures. Including this one, 10 of 14 cases reported on so far had impaired cardiovascular, hepatic or renal function or atherosclerosis. None of these patients-at-risk survived. In this series, no indications of faulty operative technique could be identified. CONCLUSION: Patient-related risk factors seem to play the most important role in the development of this rare but devastating complication. Preventive measures and methods to identify patients at risk for developing intestinal ischemia during and after laparoscopy are not completely clear. Patient selection, an optimal hydration status, an optimized technique with lowest insufflation pressure possible, and intermittent decompressions of the abdomen when the procedure is lengthy are the measures that have a potential to prevent this complication. Whatever laparoscopic procedure has been performed, intestinal ischemia should be considered in any patient with nonspecific abdominal symptoms.     

活血清解汤对重症急性胰腺炎大鼠肠道免疫屏障功能的影响及机制

背景与目的 重症急性胰腺炎（SAP）易并发肠道免疫屏障功能障碍,笔者前期发现活血清解汤可缓解SAP,但其作用是否与肠道免疫屏障功能有关尚不清楚。因此,本研究探讨活血清解汤对SAP大鼠肠道免疫屏障功能的作用及机制。方法 将SD大鼠随机分成假手术组、SAP模型组（模型组）、SAP模型+活血清解汤治疗组（治疗组）,SAP模型采用5%牛磺胆酸钠胰胆管逆行注射法诱导,治疗组造模后给予活血清解汤灌胃,假手术组与模型组给予等体积生理盐水代替。分别在术后6、12 h处死动物,ELISA检测各组血清中的促炎因子TNF-α、抗炎因子IL-4、血淀粉酶及脂肪酶的指标变化;HE染色检测胰腺及小肠组织的病理变化;qRT-PCR及Western blot检测小肠组织巨噬细胞M1型标志物iNOS及M2型标志物Arg-1的表达。将大鼠小肠巨噬细胞分别用牛磺胆酸钠、活血清解汤、牛磺胆酸钠+活血清解汤处理,以无处理的大鼠小肠巨噬细胞为空白对照,用qRT-PCR及Western blot检测各组细胞NF-κB、iNOS、TNF-α、IL-4、Arg-1、TIPE2和PPAR-γ的表达。结果 体内实验中,与假手术组比较,模型组与治疗组术后的TNF-α、IL-4、血淀粉酶、脂肪酶水平均有不同程度升高（部分P<0.05）,但治疗组TNF-α、血淀粉酶、脂肪酶升高的程度明显低于模型组,而IL-4升高的水平明显大于模型组（均P<0.05）;模型组与治疗组术后胰腺与小肠组织均出现明显的病理损伤,但治疗组的损伤程度小于模型组,且随时间延长,模型组的损伤程度加重,治疗组则减轻,模型组与治疗组胰腺与小肠组织病理评分差异均有统计学意义（均P<0.05）;iNOS蛋白与mRNA的表达在模型组小肠组织中表达明显升高,而在治疗组的小肠组织中明显降低（均P<0.05）,Arg-1蛋白与mRNA的表达模型组小肠组织后期（12 h）明显升高,而在治疗组的早期（6 h）与后期（12 h）均明显升高,且升高程度大于模型组（均P<0.05）。体外实验中,单独牛磺胆酸钠处理后的大鼠小肠巨噬细胞的NF-κB、iNOS、TNF-α蛋白与mRNA表达水平明显上升（均P<0.05）,而Arg-1、IL-4、TIPE2、PPAR-γ蛋白及mRNA表达无明显变化（均P>0.05）;单独活血清解汤处理后,大鼠小肠巨噬细胞的Arg-1、IL-4、TIPE2及PPAR-γ蛋白及mRNA表达水平明显升高（均P<0.05）,而NF-κB、iNOS、TNF-α蛋白及mRNA表达无明显变化（均P>0.05）;与单独牛磺胆酸钠处理比较,牛磺胆酸钠+活血清解汤处理的大鼠小肠巨噬细胞的NF-κB、iNOS及TNF-α蛋白及mRNA表达水平明显下降,而Arg-1、IL-4、TIPE2及PPAR-γ蛋白及mRNA表达水平明显增加（均P<0.05）。结论 中药活血清解汤对SAP大鼠的肠道免疫屏障功能有保护作用,其作用机制可能与调控小肠巨噬细胞由M1型向M2型转化,促进抗炎因子表达,抑制促炎因子的释放,进而缓解全身炎症反应有关。