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.     

腹腔镜门静脉插管皮下泵植入术(附4例报告)

目的:探讨腹腔镜门静脉插管皮下泵植入术的手术方法与技巧。方法:回顾分析4例晚期原发性肝癌患者行腹腔镜门静脉插管皮下泵植入术的临床资料。结果:4例晚期原发性肝癌患者行腹腔镜门静脉插管皮下泵植入术均获成功,无中转开腹、手术死亡及手术并发症发生,患者均于术后3d接受经皮下泵门静脉灌注化疗。结论:腹腔镜门静脉插管术安全可行,丰富的腹腔镜手术经验、手术组医师之间的协调配合与合适的病例选择是保证手术成功的关键。     

胃肠道肿瘤术后复发与肠粘连引起的肠梗阻临床分析

目的：探讨胃肠道肿瘤复发和粘连性肠梗阻的临床区别和治疗特点。方法：回顾性复习了经手术治疗的86例胃肠道肿瘤术后出现肠梗阻的临床资料，并分析其在临床上区别和治疗特点。结果：86例中粘连性肠梗阻39例，肿瘤复发47例，在复发组胃癌术后复发最为多见(P＜0．05)，原发性肿瘤分化差的其复发引起肠道梗阻明显高于分化好引起的粘连性肠梗阻(P＜0．01)。症状上肿瘤复发组出现的恶心、呕吐及肛门停止排便排气低于粘连性肠梗阻(P＜0．01)。肿瘤复发的肠梗阻表现为不全性梗阻，口服泛影葡胺治疗多能缓解，但大部分患者部分症状仍存在，粘连性肠梗阻多为完全性肠梗阻(P＜0．005)，多需要手术。结论：低分化原发肿瘤、不全性肠梗阻、低发生率的恶心和呕吐及肛门停止排便排气的肠梗阻，多提示为肿瘤的复发，泛影葡胺治疗后梗阻缓解但仍有症状存在应首先考虑是肿瘤复发。     

佛山地区1991～2000年小儿消化道出血病因研究

【目的】探讨佛山地区小儿消化道出血的临床特点，了解小儿消化道出血的病因。【方法】采用回顾性调查方法对1363例消化道出血患儿进行病因分析。【结果】1363例消化道出血患儿除全身疾病引起出血的146例外，消化道局部病变引起出血者1217例；属上消化道出血395例，确诊为溃疡病232例(57．3％)，各种类型胃炎及十二指肠球炎共123例(30．4％)，其次为食管静脉曲张、胃粘膜脱垂、食管贲门撕裂症、食管裂孔疝、十二指肠息肉等，明确病因372例(94．2％)。属下消化道出血822例，确诊为肠息肉526例(54．9％)，结肠炎121例(12．6％)，其次为溃疡性结肠炎、肠套叠、美克尔憩室、阿米巴结肠炎、小肠血管瘤、血管畸形、肠结核等，明确病因800例(97．3%)。【结论】小儿消化道出血应根据不同年龄、不同出血部位选择有效诊断方法，以提高病因诊断率，减少对患儿生长发育及身心健康的影响。     

暴发性肝功能衰竭大鼠胃肠推进运动的变化

应用硫代乙酰胺灌胃复制暴发性肝功能衰竭大鼠模型,测定了大鼠胃肠推进运动的变化,结果:暴发性肝功能衰竭大鼠胃肠推进运动较正常大鼠显著减弱。肌肉注射胃复安、西沙必利或红霉素可显著增强肝功能衰竭大鼠的胃肠推进运动,这一效应可被皮下注射阿托品所完全阻断。表明这些药物可能通过迷走神经而使胃肠推进运动增强。     

Gastrointestinal manifestations of type 1 neurofibromatosis (von Recklinghausen''s disease)

Gastrointestinal involvement in von Recklinghausen's disease occurs in three principal forms: hyperplasia of the submucosal and myenteric nerve plexuses and mucosal ganglioneuromatosis which leads to disordered gut motility; gastrointestinal stromal tumours showing varying degrees of neural or smooth muscle differentiation; and a distinctive glandular, somatostatin-rich carcinoid of the periampullary region of the duodenum that contains psammoma bodies and which may be associated with phaeochromocytoma. This review describes the histopathological features of these lesions and discusses potential pitfalls in their differential diagnosis. Their accurate identification has significant implications for clinical management and may even provide the first pointer to the diagnosis of neurofibromatosis.     

Effects of Spascupreel versus hyoscine butylbromide for gastrointestinal cramps in children

BACKGROUND: Gastrointestinal spasms and cramps are common in children as well as in adults. Alternative medical practices such as chiropractice and homeopathy are becoming increasingly popular in Europe and the USA. The effectiveness and tolerability of the homeopathic preparation Spascupreel was compared with that of hyoscine butylbromide treatment in children <12 years of age. METHODS: An observational cohort study in 204 children <12 years was conducted over a 1 week treatment period. The efficacy of the respective therapies were evaluated on the effect on severity of spasms and clinical symptoms (pain/cramps, sleep disturbances, distress, eating or drinking difficulties and frequent crying). Compliance was evaluated on a four-point scale from 'very good' to 'low'. Evaluation was done by the practitioner based on information given by the patient or minder. RESULTS: The analysis showed comparative improvements with the homeopathic preparation and hyoscine butylbromide therapy on severity of spasms, pain/cramps, sleep disturbances, eating or drinking difficulties, and frequent crying, all as evaluated by the practitioner. Both treatments were very well tolerated. CONCLUSIONS: For patients opting for a homeopathic therapy, Spascupreel seems to be an effective and well tolerated alternative to conventional therapies in children suffering from gastrointestinal spasms.     

Convergence of Genetic, Nutritional and Inflammatory Factors in Gastrointestinal Cancers

Gastrointestinal cancers account for 20% of all cancer incidences worldwide. Colorectal cancer is the second most common cause of all cancer-related mortality and is increasing in Western societies. Infection and inflammation contribute to 15–20% of all malignancies, and are predisposing risk factors for gastrointestinal cancers. Helicobacter pylori infection is commonly associated with gastric cancers, and chronic inflammation increases the risk of colorectal cancer by 1% per year. Micronutrient status and common genetic variations in human populations modify risk for gastrointestinal cancer. Chronic inflammation promotes carcinogenesis by inducing gene mutations, inhibiting apoptosis, and stimulating an-giogenesis and cell proliferation. Inflammation also induces epigenetic alterations that are associated with cancer development. Two key genes in the inflammatory process, cyclooxygenase-2 (COX-2) and nuclear factor-kappa B (NF-kB), provide a mechanistic link between inflammation and cancer and are targets for chemoprevention. Dietary components, and human genetic variation that affects nutrient utilization, can directly modify inflammatory processes and/or suppress genomic alterations that are the molecular antecedents of cancers. The present report focuses on the convergence of genetic, nutritional, and inflammatory factors in the initiation and progression of gastrointestinal cancers, and the emerging dietary strategies for cancer prevention.     

Central tumour necrosis factor-α mediates the early gastrointestinal motor disturbances induced by lipopolysaccharide in sheep

Cytokines are involved in fever and other symptoms of the acute phase response induced by endotoxins. The aim of this work was to study the involvement of central tumour necrosis factor-alpha (TNF-alpha) in the changes induced by lipopolysaccharide (LPS) on gastrointestinal (GI) motility in sheep. Body temperature and myoelectric activity of the antrum, duodenum and jejunum was recorded continuously. Intravenous (i.v.) administration of LPS (0.1 micro g kg-1)-induced hyperthermia, decreased gastrointestinal myoelectric activity and increased the frequency of the migrating motor complex (MMC). These effects started 40-50 min after LPS and lasted for 6-7 h. TNF-alpha (50 and 100 ng kg-1) mimicked these effects when injected intracerebroventricularly (i.c.v.) but not i.v. Pretreatment with soluble recombinant TNF receptor (TNFR:Fc, 10 micro g kg-1, i.c.v.) abolished the TNF-induced actions and reduced those evoked by LPS. Furthermore, the effects induced by either LPS or TNF were suppressed by prior i.c.v. injection of indomethacin (100 micro g kg-1). In contrast, the i.v. injections of TNFR:Fc or indomethacin were ineffective. Our data suggest that LPS disturbs GI motility in sheep through a central pathway that involves TNF-alpha and prostaglandins sequentially.