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 Gastric residual contents were withdrawn into a Luken's trap, and pH was then determined and gastric volume indexed to weight (ml.kg-1).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).     

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.     

脑卒中偏瘫康复训练程序化研究

目的 :观察脑卒中偏瘫患者进行康复训练的疗效。方法 :2 2例脑卒中患者 :康复组 12例 ,对照组 10例。 2组均接受神经科常规药物治疗。康复组按“中风后程序化康复训练表”进行康复训练 ,分别于康复前、康复后 1月和 3月进行疗效评定。结果 :日常生活活动能力量表 (ADL)测评结果显示 :康复组有效率 83 3% (10 / 12 ) ,对照组 30 % (3/10 ) ,2组差别有显著意义 (P <0 0 5 )。神经功能缺损评分结果显示 :康复组有效率 91 7% (11/ 12 ) ,对照组 4 0 % (4 / 10 ) ,2组差别有显著意义 (P <0 0 1)。结论 :康复训练能降低脑卒中偏瘫患者的致残率 ,提高生活质量。     

新生儿颅内出血的临床分析

目的 为探讨各种类型新生儿颅内出血的早期诊断方法，明确其临床特点与CT的关系。方法 对176例经CT证实有颅内出血新生儿的临床资料进行回顾性分析。结果 176例患儿中缺氧所致123例(72．6％)，产伤21例(11．9％)，新生儿出血症22例(12．5％)，早产儿10例。患儿有意识障碍者156例(88．6％)，惊厥98例(55．68％)，肌张力改变113例(64．2％)，原始反射减弱或消失104例(59％)，贫血16例。CT示：SAH121例。占68．75％，为NICH最常见类型；SDH17例，IPH13例，IVH5例，混合性出血20例。结论 根据临床表现考虑NICH者应做头颅CT或头颅B超检查。Cr是确诊的最佳手段，能正确显示出血部位、范围、程度及区分各种类型，头颅B超对早产儿、低出生体重儿的IVH、IPH检出率高。     

简易立体定位仪定位微创治疗高血压脑出血

目的　探讨高血压脑出血微创治疗的方法和手术时机的选择对该病疗效的影响。方法　对 12例高血压脑出血患者 ,采用脑内血肿定位仪微创血肿穿刺引流术清除血肿 ,观察疗效。结果　ADL1～ 3级 75 % ,病死率 8.3%。结论　颅内血肿定位仪定位微创血肿穿刺引流术 ,具有效果肯定、定位准确、损伤轻微、适应症广的特点 ,超早期治疗是预后的关键     

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.     

Dotlike Hemosiderin Spots Are Associated With Past Hemorrhagic Strokes in Patients With Lacunar Infarcts

BACKGROUND AND PURPOSE: Dotlike hemosiderin spots ongradient-echo T2(*)-weighted magnetic resonance imaging of the brain have been histologically diagnosed as old microbleeds associated with small vessel disease (SVD). The authors hypothesize that the presence of many dotHSs may be correlated with the fragility of small vessels and the recurrence of SVD, including lacunar infarction and deep intracerebral hemorrhage (ICH). METHODS: To investigate how dotHSs are related to past history of SVD, the number of subcortical or deep dotHSs was investigated in 146 patients with lacunar infarctions (95 men, 51 women, age 38 to 90 [66.6+/-9.4] years). They were divided into 2 subgroups according to history of deep ICHs or lacunar infarctions. The odds ratio (OR) for past history was estimated from logistic regression analyses with the number of subcortical or deep dotHSs as well as other factors. RESULTS: Of 146 patients with lacunar infarctions, 11 had past symptomatic ICHs and 19 had past symptomatic lacunar infarctions. An elevated rate of history of ICH was found for lacunar infarction patients with many deep dotHSs (>or=3; OR, 9.1; 95% confidence interval, 1.6-51, P=.015). However, history of lacunar infarction was not significantly associated with the number of subcortical or deep dotHSs. CONCLUSIONS: Our findings suggest that many deep dotHSs on T2(*)-weighted magnetic resonance imaging may be correlated with deep ICH-lacunar infarction type of SVD recurrence but not lacunar infarction-lacunar infarction type.     

Measurement of blood loss at childbirth and postpartum.

OBJECTIVE: To accurately measure blood loss during childbirth in a developing country. METHOD: The alkaline hematin technique was used to quantify blood lost during delivery and 24 h postpartum in 158 women in Pemba Island, Zanzibar. RESULT: Women were found to lose less blood during childbirth and 24 h postpartum than previously reported. Compared with laboratory values, nurse-midwives approximated blood loss accurately (mean difference, i.e., mean underestimation by nurse-midwives, 4.90 mL); however, their imprecision was greater for higher laboratory values. CONCLUSION: This study may prompt further investigation, as no comparable data exist for developing countries where maternal mortality is high and severe anemia prevalent.     

脑干出血的CT诊断与预后评估

目的 探讨脑干出血的CT诊断与预后评估的意义。方法 通过对48例脑干出血病例的临床治疗与CT资料分析，探讨脑干出血的位置、大小、出血量与治疗及预后的关系。结果 脑干平均出血量G=3．3675ml，病死率与出血量有关，出血量小于5ml病死率为35．71%（17．97-53．46％)。早期诊断与治疗是影响预后的关键。结论 CT是目前脑干急性出血快速、准确的检查手段，对其临床治疗及预后评估有重要的价值。     

Ischemic and hemorrhagic cerebral lesions of the newborn

Neonatal pathology comprises a large array of cerebral lesions due to ischemic and/or hemorrhagic mechanisms. Pathogenesis, neuropathology, clinical settings in the acute stages as well as short and long-term outcome are discussed.