原发性胃肠道淋巴瘤的诊断与治疗

目的探讨原发性胃肠道淋巴瘤的诊治经验。方法回顾性分析12例原发性胃肠道淋巴瘤,均行剖腹探查,其中行根治性切除7例,姑息性手术3例,肿块活检术2例。结果胃淋巴瘤5例,肠淋巴瘤7例。病理分类:弥漫性非何杰金氏淋巴瘤9例,粘膜相关性淋巴瘤2例,高度恶性淋巴瘤1例。Ann Arbor临床分期:ⅡE期3例,ⅢE期7例,ⅣE期2例。平均随访18(6~72)月,6例存活,死亡6例。结论内镜和消化道造影是淋巴瘤主要诊断手段,手术切除为主的综合治疗为最佳治疗方案。     

A retrospective study on estrogen or contraceptives in the treatment of dysfunctional uterine bleeding in adolescent patients

Objective: To investigate the clinical efficacy of estrogen or contraceptives in the treatment of acute bleeding of dysfunctional uterine bleeding (DUB) in adolescent patients and the optimal starting dosage of drugs.Methods: The clinical records of 106 girls who with DUB and moderate or severe anemia from February 1990 to July 2005 were analyzed retrospectively.Results: All 106 patients received hormonal therapy. 56 patients were treated with estradiol benzoate(E2), 30 patients with conjugated equine estrogen(CEE) and 20 patients with combined oral contraceptives (COCs). The rates for rapidly controlling bleeding and for rapidly stopping bleeding in E2 group were higher than those in CEE group ,but similar to those in COCs group. The days for controlling and completely stopping bleeding were not significantly different between the starting dosages (≤8 mg/d and >8 mg/d) of E2 groups, and also there were no statistical difference between the starting dosages (<7.5 mg/d and ≥7.5 mg/d) of CEE groups, but during the treatment the rate of increasing the dosage in <7.5 mg/d group was higher than that of ≥7.5 mg/d group(40% vs. 5%),while there were no statistical difference between the starting dosages (≤3 pills/d and >3 pills/d) of COCs groups. Conclusions: The clinical efficiency of E2 treatment on DUB in adolescent patients is similar to that of COCs. And the efficacies of treatment of DUB with E2, CEE and COCs in the different dosages are similar.     

Ghrelin does not stimulate gastrointestinal motility and gastric emptying: an experimental study of conscious dogs

Ghrelin is a peptide that was discovered in endocrine cells of the stomach. However, its action in regulating the fasted and fed motor activity of the digestive tract is not fully understood. In the present study, we examined the effects of an intravenous (i.v.) injection of canine ghrelin on the physiological fasted and fed motor activities in the stomach, duodenum, jejunum and colon of freely moving conscious dogs. An i.v. injection of canine ghrelin released growth hormone in a dose-dependent manner; however, it did not stimulate the motor activity of the digestive tract in either the fasted or the fed state. Moreover, an i.v. injection of high-dose canine ghrelin significantly reduced the motility index in the gastric body in the fasted state. Ghrelin did not accelerate gastric emptying, either. These results differ from previous reports dealing with rodents. It is significant that such results were obtained in research with dogs, which are larger animals.     

Free flap reconstruction of the lower extremity in the elderly

Summary Over a four year period, thirteen patients over the age of 60 (mean 69 years) underwent reconstruction of lower extremity defects with free tissue transfers. Ten latissimus dorsi, one tensor facia lata, and two rectus abdominus free flaps were used. Despite significant risk factors which included previous tobacco use, hypertension, diabetes mellitus, and angiographic vessel abnormalities, ten of thirteen cases had successful outcomes. There was one acute flap failure secondary to arterial thrombosis. Four flaps had delayed healing, with one patient eventually requiring amputation secondary to persistent pain and wound drainage. This experience demonstrates that free flap reconstruction of lower extremity defects in the elderly patient is a reasonable alternative to amputation when other options are limited.From the Section of Plastic and Reconstructive Surgery at the Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA Requests for reprints: J. Fisher, M.D.     

选择性腹部动脉造影对原因不明消化道出血10例的诊断

应用选择性腹部动脉造影诊断原因不明消化道出血10例,发现病变者7例;小肠平滑肌瘤2例,小肠血管病变4例,胆道出血1例。6例作了手术,术前和术后诊断相符者5例。     

Endoscopic laser pancreatic cystogastrostomy

Traditionally the drainage of pancreatic pseudocysts has been carried out operatively, forming a cystenterostomy. A simple endoscopic method of forming a pancreatic cystogastrostomy with laser is presented. This procedure does not require a general anesthetic, is safe, and allows resolution of symptoms.     

Effect of meal volume on gastric emptying

Abstract While the volume of a liquid meal has been identified as the principal accelerator of gastric emptying of liquids, the relationship between meal volume and gastric emptying of solids has been controversial. With solid foods, the need to reduce solid foods into small particles (trituration) before passage might obscure the effect of meal volume on solid propulsion. To distinguish trituration from driving force as the rate-limiting factor for emptying, 75 (1.6 mm) nylon spheres were fed along with different amounts of steak meals (150, 300 and 600 g), or alternatively, 50, 100 or 200 (1.6 mm) nylon spheres were fed to six dogs with 300 g steak meals. To examine the effect of meal volume on gastric emptying, we studied the effect of different meal volumes on the speed of gastric emptying of liquids (150, 300, 600 and 1200 ml of phosphate buffer) and solids (150, 300 and 600 g of cooked beef steak) in five dogs with duodenal fistulas. Intestinal inhibition was eliminated by diverting all chyme through the fistulas. In the absence of intestinal feedback, we found that gastric emptying of steak and spheres were different in that steak emptying was independent of meal volume (g min^-1 was constant across 150–600 g) while sphere emptying was affected by the number of spheres in the stomach and that liquid emptying was dependent on the meal volume (ml min^-1 increased across 150–1200 ml). Thus, meal volume accelerated gastric emptying provided the process is not rate-limited by trituration.     

下肢静脉病变顺、逆行造影的诊断价值

目的:探讨下肢静脉病变顺、逆行造影X线表现与病理改变的关系。方法:回顾性分析86例(119侧)下肢静脉病变顺、逆行造影X线表现。结果:顺行造影显示原发性下肢深静脉瓣膜关闭不全84侧,交通静脉瓣膜关闭不全14侧,单纯性瓣膜关闭不全11侧,静脉瘤或弥漫性血管湖6侧,先天性下肢静脉发育异常4侧。逆行造影显示0级13侧,Ⅰ级58侧,Ⅱ级21侧,Ⅲ级19侧,Ⅳ级8侧。结论:下肢静脉病变顺、逆行同时造影能更好地显示下肢浅、深静脉瓣膜功能,为临床诊断或治疗提供非常有价值的依据。     

原发性胃肠道粘膜相关淋巴组织淋巴瘤47例临床病理分析

目的 探讨原发性胃肠道粘膜相关淋巴组织淋巴瘤(GIL-MALT)的临床病理特点。方法 回顾性分析1990～2000年我院经手术及病理证实的47例胃肠道MALT患者临床病理资料。结果 47例患者平均年龄57．2岁，男女比例2．1：1。以腹痛和发热为主。病变分布为胃32例，小肠4例，回盲部及盲肠5例，大肠6例。内窥镜下息内型15例，溃疡型25例，弥漫型7例。除1例为T细胞淋巴瘤，其余均为B细胞淋巴瘤。结论 胃肠道粘膜相关淋巴瘤以中老年为主，男性居多，临床误诊率较高。内窥镜下多次多点活检、深凿活检可提高本病的确诊率。     

肢体缺血预处理对兔肺缺血再灌注损伤的影响

目的 探讨肢体缺血预处理对兔肺缺血再灌注损伤的影响.方法 健康日本大耳白兔18只,体重2.0～2.5 kg,雌雄不拘,随机分为3组(n=6):假手术组(S组)开胸后左侧肺门穿线但不结扎,旷置观察340 min;缺血再灌注组(IR组)开胸旷置100 min,阻断左侧肺门,左肺不张后60 min再灌注180 min;肢体缺血预处理组(L组)捆绑双后肢10 min,松开10 min,反复3次后恢复灌注,60 min后阻断左侧肺门60 min,再灌注180 min.于缺血前、再灌注15、30、60、120、180 min时采集左颈内动脉血样行血气分析,计算呼吸指数(R1);于再灌注180 min时处死动物,取左肺上叶组织,测定超氧化物歧化酶(SOD)、髓过氧化物酶(MPO)活性及丙二醛(MDA)含量,计算肺湿干重比(W/D);取左肺下叶行支气管肺泡灌洗,计算肺通透性指数;取左肺中叶组织,观察肺组织病理学,进行弥漫性肺泡损伤(DAD)评分.结果 与s组比较,IR组RI、MDA含量、MPO活性、肺W/D、肺通透性指数和DAD评分升高,SOD活性降低(P<0.05或0.01);与IR组比较,L组RI,MDA含量、MPO活性、肺W/D、肺通透性指数和DAD评分降低,SOD活性升高(P<0.05或0.01);L组和S组间上述指标比较差异无统计学意义(P>0.05).L组和S组肺组织病理损伤程度较IR组减轻.结论 肢体缺血预处理可减轻兔肺缺血再灌注损伤.