Single-dose oral omeprazole for reduction of gastric residual acidity in adults for outpatient surgery

Omeprazole is a substituted benzimidazole that causes dose-dependent intracellular inhibition of gastric acid secretion in humans. This double-blind study examined the effect of omeprazole in decreasing gastric acidity and gastric residual volume in outpatient adults. Unpremedicated outpatients, ASA I-III, 18 years or older (n = 17), were randomly assigned to receive omeprazole 80 mg, or placebo by mouth the night before scheduled elective outpatient surgery. The patients were fasted for 8 h prior to surgery. After the patient was anesthetized, an orogastric tube was inserted with proper placement verified by auscultation for gastric sounds. Gastric residual contents were withdrawn into a Luken's trap, and pH was then determined and gastric volume indexed to weight (ml.kg-1). Data were analyzed by a t-test, with P less than 0.05 considered statistically significant. Patient characteristics of both groups were similar. There was a statistically significant difference between the two groups for pH (P = 0.02), but not between the two groups for gastric volume indexed to weight (P = 0.07).     

The callous elbow and aging of the upper arm

The author describes his surgical approach to the problems of the aging upper arm and elbow region. Surgery at an appropriate age can prevent the progressive wrinkling of the elbow which is further aggravated by aging of the upper arm. The author's operation is aimed at correcting both portions of the arm anatomy at the same time.     

Assessment of long-term quality of life after laparoscopic and open surgery for Crohn''s disease

OBJECTIVE: Surgery for Crohn's disease (CD) is associated with a high recurrence rate and quality of life (QOL) in these patients is controversial. The aim of this study was to assess QOL in patients after laparoscopic and open surgery for CD by two different validated instruments, a generic nonspecific score and a specific gastrointestinal QOL index. PATIENTS AND METHODS: Patients with CD who underwent elective laparoscopic or open ileocaecal resection with primary anastomosis between 1992 and 2000 were followed for recurrence and surgery-related complications. QOL was assessed by the SF-36 Health Survey containing a mental (MCS) and a physical (PCS) component summary score and by the Gastrointestinal Quality of Life Index (GIQLI) developed by Eypasch. RESULTS: Thirty-seven patients with a mean age of 48.8 +/- 18.4 years including 23 females and 14 males were evaluated at a mean follow-up of 42.6 +/-25.8 months (minimum of 8 months). Twenty-one (57%) patients underwent laparoscopic resection and 16 (43%) open surgery. Both groups were well matched for age, gender, ASA class and body mass index. Fourteen (38%) patients developed recurrent disease and 3 (8%) had postoperative incisional hernias. Overall, QOL scores were 103 +/- 26.8 for the GIQLI, 47.2 +/- 11.8 for the PCS, and 49.2 +/- 11.5 for the MCS. The GIQLI correlated well with the SF36, correlation coefficient = 0.68 for GIQLI vs PCS (95% CI, 0.41,0.95) and 0.67 for GIQLI vs MCS (95%CI, 0.39, 0.95), respectively. When compared to the general US population, mean GIQLI scores (-13.8, P = 0.002) and mean PCS scores (-4.7, P = 0.001) were significantly lower in these patients than in healthy individuals. In a multivariate analysis of impact factors on QOL, recurrence within the follow-up period was the single significant determinant reducing the PCS (-35.1, P = 0.026) and the GIQLI (-36.1, P = 0.018). CONCLUSION: QOL is significantly reduced in patients with CD at long-term follow-up after both laparoscopic and open surgery. Recurrence is the only factor adversely affecting QOL of CD patients in remission irrespective of the operative technique applied.     

An approach to haemorrhoids

OBJECTIVE: Many patients with haemorrhoids are investigated because of the fear of missing colorectal cancer (CRC). The aim of this study was to determine whether a primarily clinical approach regarding the need for investigation was safe and did not miss patients with CRC. PATIENTS AND METHODS: Data was collected prospectively on 589 consecutive patients with the principle diagnosis of haemorrhoids at first clinic visit. All had clinical assessment including rigid sigmoidoscopy and were treated by phenol injection or banding. They were categorized for (1) no review unless symptoms persisted -'One Stop SOS' (2) outpatient review or (3) investigation. To check for the development of CRC they were contacted by postal questionnaire or telephone interview with a minimum of one year from diagnosis and treatment. All 589 patients were cross-referenced with the Pathology database and the Hospital Information Services System. RESULTS: Four hundred and sixty-nine (80%) answered the questionnaire; 352 patients (60% of the total group) fell in the 'one stop SOS' outpatient category; 95 (16%) patients were followed up to review response to treatment for large haemorrhoids; 105 (18%) were investigated with barium enema (12%), flexible sigmoidoscopy (4%), colonoscopy (1%) and miscellaneous (1%); 37 (6%) patients were either given a haemorrhoidectomy date or referred on with a different diagnosis. No patients selected for 'one-stop' treatment developed CRC. Five (0.8%) patients were diagnosed with CRC after appropriate investigation was instituted for suspicious symptoms. One patient with distal transverse colon cancer had a delayed diagnosis as she was investigated initially by flexible sigmoidoscopy. CONCLUSION: Most patients with the primary diagnosis of symptomatic haemorrhoids do not need investigation.     

Bleeding from foveolar hyperplasia developing on a gastrointestinal stromal tumor of the stomach

A 52‐year‐old Japanese woman who presented with gastrointestinal (GI) bleeding underwent a proximal gastrectomy for a gastrointestinal stromal tumor (GIST) with a foveolar hyperplasia at the apex of the tumor, 4.5 cm in size, located in the upper body of the stomach. Although GIST are often asymptomatic and are found only incidentally, clinical symptoms such as bleeding, abdominal pain, or obstruction, occasionally lead to a premorbid diagnosis. When submucosal tumors present GI bleeding, the source of the bleeding usually is an ulceration of the mucosa over the tumor. However, in the present study, it was thought that the bleeding originated from the region of foveolar hyperplasia.     

In vitro growth of epithelial cells from mucosa derived from different regions of the gastrointestinal tract

Attempts have been made to culture the mucosa from various parts of the gastrointestinal tract. In this study, using an explant culture method, epithelial cells have been successfully cultured from all major regions of the gastrointestinal tract. The success rate, as judged by outgrowth of epithelial cells for at least 4 weeks, varied with the tissue studied with 19/50 colonic biopsies, 5/11 small intestinal biopsies, 9/12 stomach biopsies and 42/47 gallbladder biopsies yielding outgrowth of epithelial cells. Differentiation of the epithelial cells along the mucus cell pathway could be demonstrated on the monolayer cultures using Periodic acid Schiff or Alcian blue staining. Because the cultures were very heterogeneous and many morphological cell types were present in most cultures, differentiation along the other known differentiation pathways of the gastrointestinal mucosa, such as development of absorptive cells and endocrine cells, could not be excluded.
The problem of bacterial contamination, which has hindered previous studies on tissue from these sites, was overcome by decontaminating the biopsy by soaking in dilute sodium hypochlorite (0.04%).     

内眦赘皮与重睑成形同期手术的一种新方法

目的 探索适合同时行重睑成形术和内眦赘皮矫正术的新方法。方法 根据内眦赘皮深部眼轮匝肌结构上的异常特点，遵循内眦赘皮的上睑（倒向性内眦赘皮除外）内侧睑缘处皮肤短缺和尽量减少局部皮肤瘢痕的原则，设计适合同时行重睑成形术的新内眦赘皮矫正术（反Stallard法）。结果 临床应用86例，进行了为期6个月以上的随访，结果所有患者的重睑为稳定性平行型重睑，内眦已完全或大部分开大，手术效果满意。结论 此内眦赘皮矫正术能够充分矫正内眦部结构上的异常，而且适合与重睑成形术同期施行，是一种效果稳定，结果满意的术式。     

无排卵性功能失调性子宫出血患者子宫内膜雌、孕激素受体及基质金属蛋白酶表达变化的研究

目的研究无排卵性功能失调性子宫出血(功血)患者子宫内膜雌激素受体(ER)、孕激素受体(PR)、IV型胶原、基质金属蛋白酶-9(MMP-9)及其抑制物-1(TIMP-1)的表达,探讨无排卵性功血的发病机制。方法采用免疫组化法检测20例正常增殖期子宫内膜(对照组)和66例无排卵性功血患者(病例组)子宫内膜腺上皮和基质细胞ER、PR、IV型胶原、MMP-9及TIMP-1表达。结果病例组子宫内膜腺上皮和基质ER、PR表达高于对照组(P<0.05),MMP-9水平明显增加(P<0.05),MMP-9/TIMP-1比值升高(P<0.01),IV型胶原含量明显下降(P<0.01)。相关分析显示,无排卵性功血患者子宫内膜MMP-9水平与ER、PR均呈正相关(r=0.605,P<0.05;r=0.697,P<0.05)。结论无排卵性功血患者子宫内膜出血原因可能与雌激素作用下ER、PR表达失调有关,且MMP-9水平异常升高,导致细胞外基质过度降解,临床表现为子宫不规则出血。     

多层螺旋CT尿路造影对上尿路梗阻性疾病的诊断价值

目的 探讨多层螺旋CT尿路造影（MSCTU）在上尿路梗阻性疾病诊断中的价值。资料与方法 搜集经静脉肾盂造影（IVU）或其他影像学检查提示上尿路梗阻而原因不明的患者58例，均行MSCTU检查，在图像工作站对获得图像进行最大密度投影（MIP）、多平面重建（MPR）及容积再现（vRT）等三维后处理，获得泌尿系立体图像。结果 58例中上尿路结石20例，先天性畸形14例，输尿管癌11例，输尿管炎性狭窄3例，输尿管息肉2例，副肾血管压迫肾盂输尿管交接处2例，邻近器官疾病导致上尿路梗阻2例，以上病例均经手术或输尿管镜检查证实。另有4例无法确诊，诊断准确率为93．10％。结论 MSCTU通过MPR、MIP、VRT技术多角度观察能够更加清晰地显示出导致上尿路梗阻的病变及其形态，在上尿路梗阻病变诊断方面有独特的优势。     

美宝胃肠胶囊对胃肠道黏膜保护作用的疗效观察

目的：验证美宝胃肠胶囊(GIC)治疗常见的上消化道疾病的治疗效果。方法：选择门诊具有上消化道症状,临床病例共60例,经内镜确诊的十二指肠球炎、十二指肠球霜样溃疡等15例,溃疡病15例,作为治疗组,分别单独服用美宝胃肠胶囊及服用美宝胃肠胶囊加用质子泵抑制剂(包括其他抑酸剂)；对照组则为单独服用胃肠黏膜保护剂麦滋林-S 15例,及服用麦滋林-S加用质子泵抑制剂(包括其他抑酸剂)15例；疗程完成后治疗组及对照组均复查胃镜,记录镜下溃疡愈合或炎症改变情况。结果：治疗1组(美宝胃肠胶囊组)的治愈率为80．0%,治疗2组(美宝胃肠胶囊组十质子泵抑制剂)的治愈率为73．3%,对照1组和对照2组均为66．7%,且副作用小。结论：美宝胃肠胶囊是既能治疗上消化道疾病,又少有毒副作用,价格合理的药物,值得进一步观察、研究、推广。