INVASIVE MUCORMYCOSIS WITH GASTRIC INVOLVEMENT IN A PATIENT WITH SEVERE ATHEROMATOUS VASCULAR DISEASE

Gastric mucormycosis involvement is a rare condition that usually occurs in inmunocompromised patients and frequently has a fatal outcome. We report the case of a 73‐year‐old woman admitted to the intensive care unit with severe bleeding after an acute pulmonary disease. Upper endoscopy disclosed wide and deep necrotic ulcers in the body and fundus of the stomach and greenish exudates with the antrum and the duodenum undamaged. Autopsy revealed an invasive mucormycosis and a severe atheromatosis. Several predisposing factors for mucormycosis infection have been reported until now. We postulate that ischemic gastritis could be a predisposing factor for colonization of zygomycete.     

Lähmung des N. hypoglossus nach operativem Eingriff – Behandlung mit Akupunktur

Acupuncture is able to accelerate the process of healing significantly when employed in cases of nerve paresis as shown in the following analysis. The patient's constant condition of speech and swallowing impediment before treatment changed relatively fast after starting acupuncture treatment. It is self evident that we took into account the primary disease (AIDS) and its problems. The simplicity of a complementary treatment with acupuncture according to the possible results should make us consider the use of acupuncture as an important way to treat paresis in the early subacute phase and if possible during clinical stay.     

Fracture separation of the articular pillar of C5 following brass knuckles trauma

We report the case of a fracture separation of the articular pillar at the lower cervical spine. The trauma, following a brass knuckles, repeats almost in an experimental way the rotation and extension mechanism given in literature for the genesis of such injuries. From the admission in the orthopaedic service to the surgery, the development went in a characteristic way towards a rotatory displacement. Received: 12 July 2002, Accepted: 18 August 2002 Correspondence to: R. Massicot     

功能性便秘患儿胃肠传输时间的测定

目的 :采用不透X线标志物测定功能性便秘患儿和正常儿童全胃肠传输时间口 盲传输时间 ,结肠传输时间及分段结肠传输时间的正常值 .方法 :通过口服不透X线标志物 ,用X线拍片法分别于 12 ,2 4和 4 8h摄腹部平片 ,测定 6 8名正常儿童全胃肠传输时间 (totalgastrointestinaltransittime,TGITT)、口 盲时间 (mouth intestinetransittime ,M ITT)和结肠传输时间 (colonictransittime ,CTT) .结果 :正常儿童及FC患儿的 5 0 %全胃肠、口 盲、全结肠传输时间分别为 (2 3.6± 1.6 )h ,(9.9± 1.4 )h ,(14 .8± 1.8)和 (80 .4± 2 .1)h ,(2 0 .7± 0 .6 )h ,(5 9.9± 2 .3)h .节段性结肠传输时间包括 :右半结肠传输时间 (rightcolonictransittime,RCTT) ;左半结肠传输时间 (leftcolonictransittime ,LCTT)和直肠乙状结肠传输时间 (rectosigmoidcolonictransittime,RSTT)分别为 (7.3± 1.1)h ,(3.4± 0 .8)h ,(4 .1± 1.2 )和 (2 0 .3± 1.2 )h ,(12 .8± 1.7)h ,(2 6 .8± 1.4 )h .结论 :正常儿童胃肠传输时间与正常成人和功能性便秘患儿比较有显著差异 (P <0 .0 1) .胃肠传输时间测定可了解全胃肠及各段的动力情况 ,对功能性便秘的诊断及评估治疗效果有实用意义     

下肢静脉机能不全的应变容积描绘仪检查

本文报告我院外科1985～1987年,使用应变容积描绘仪检查下肢深静脉机能不全30例。其中28例同时行Doppler超声检查,27例行静脉造影检查。介绍了测量最大静脉输出量,最大静脉逆流量和静脉再充盈时间的方法和结果,叙述了该技术的原理,在诊断下肢静脉机能不全时,应变应变容积描绘仪是较好的无损伤检查技术。     

颈外动脉栓塞在耳鼻咽喉科的应用

在耳鼻咽喉科手术中应用颈外动脉栓塞法１０例，形成栓塞组，并把单纯颈外动脉结扎１０例作为对照组。结果表明：栓塞组较对照组术中出血量显著减少，有利于病灶彻底清除，因而有提高治愈率减少复发率的作用。掌握栓塞位置、栓塞剂用量和注射速度是防止并发症的关键。     

妇科阴道流血的鉴别及护理对策

目的探讨有关阴道异常流血的鉴别及有关护理的问题.方法在护理工作中通过对妇科异常阴道流血的原因进行分析鉴别,并采取相应的护理措施.结果总结出针对性护理方面的异同点.结论对提高护士的护理诊断能力,加强工作的计划性和预见性,及时做好急救准备有着重要的意义.     

Impact of gastrointestinal endoscopy on HIV‐infected children

Objective: To evaluate the role of gastrointestinal (GI) endoscopy in human immunodeficiency virus (HIV)‐infected children with GI problems. Methods: From 1998 to 2002, we retrospectively reviewed all cases of HIV‐infected children presenting with GI problems in which an upper or lower GI endoscopy was indicated. The initial diagnostic endoscopic examination and any repeat endoscopic session leading to a new diagnosis were used in the data analysis. Tissue biopsies were obtained from all abnormal lesions and representative sites of normal‐appearancing GI mucosa. Results: Fourteen patients (median age: 22.5 months) underwent 23 sessions of GI endoscopy, including 10 esophagogastroduodenoscopy, nine colonoscopy and four flexible sigmoidoscopy. Chronic diarrhea was the most common indication, followed by lower GI bleeding, abdominal/retrosternal pain, dysphagia/odynophagia, and upper GI bleeding. Gross endoscopic abnormalities were observed in 78.3%; whereas histological inflammation and opportunistic pathogens were identified in 87% and 43.5%, respectively. Cytomegalovirus was the most common identified pathogen. Abnormal gross findings were significantly associated with histological inflammation and identification of pathogens (P = 0.006 and 0.046, respectively). Specific changes in medical management were made in 50% of cases as a result of endoscopic investigation. Conclusion: If non‐invasive investigations for HIV‐infected children with GI symptoms fail to establish a diagnosis, gastrointestinal endoscopy should be performed and often yields a positive result leading to changes in medical management.     

Intraoperative packing of a pancreatic pseudocyst complicated with bleeding pseudoaneurysm

Hemosuccus pancreaticus (HP) is a rare cause of gastrointestinal bleeding, usually due to rupture of a visceral artery aneurysm in chronic pancreatitis. Other causes of HP are rare. We present a case of HP which occurred in a patient with chronic calcifying pancreatitis and a pancreatic pseudocyst documented by ultrasonography and computed tomography. With detectable fresh blood in the descending duodenum, an aneurysm in the pancreatic head was revealed by superior mesenteric angiography as the suspected origin of intermittent bleeding from the pancreatic duct. Because an artery feeding the pseudocyst could not be identified, angiographic embolization was not possible. Surgical resection or ligation was difficult by laparotomy; therefore, intraoperative packing of the pseudocyst with absorbable gelatin sponges was achieved via a cannula through a directly punctured site in the pseudocyst wall. The patient has been followed for 4.25 years with no further episodes of HP. It is possible that the packing of a pancreatic pseudocyst with gelatin sponges is a method that can be used in similar cases, where control of hemostasis is the primary concern. The packing of a pancreatic pseudocyst with gelatin sponges is a technique that can be performed not only via laparotomy but also via laparoscopy or concomitant angiography and ultrasonography.     

MANAGEMENT TO PREVENT BLEEDING DURING ENDOSCOPIC SUBMUCOSAL DISSECTION USING THE FLUSH KNIFE FOR GASTRIC TUMORS

The gastric vasculature responsible for intraoperative bleeding in endosocpic submucosal dissection (ESD) is the ramified vascular network occupying the middle of the submucosal layer and large vessels penetrating the muscle layer. Appropriate management for these vessels must be addressed. The trimming of the ramified vascular network can be safely performed with coagulation mode following shallow mucosal cutting. A large penetrating vessel usually requires precoagulation prior to dissection. These procedures are effectively performed with the water jet short needle knife (Flush knife).