Gastric Perforation and Death after the Insertion of an Intragastric Balloon

We report a case of a patient who presented with an acute abdomen 2 days after the insertion of an intragastric balloon system and discuss in detail the advantages and drawbacks of these devices in the therapy of morbid obesity. A 43-year-old morbidly obese man was admitted to the department of surgery in shock with a 2-h history of severe diffuse abdominal pain and the initial diagnosis of visceral perforation. The patient had been subjected to intragastric placement of an inflatable balloon 48 h prior to his presentation. Abdominal exploration revealed the presence of a large linear perforation in the fundus of the stomach.     

食管扩张治疗18例贲门失弛缓症的临床体会

目的总结食管扩张治疗的贲门失弛缓症的疗效。方法在内镜或X线监视下,用探条或气囊/水囊对18例确诊为贲门失弛缓症的患者进行扩张治疗。结果18例患者经扩张治疗后症状均获显著改善,能进普食或半流质饮食,近期有效率达100%。结论食管扩张术以其微创、痛苦小、见效快、治愈率高、并发症少、费用低廉,适合各级医院使用。     

可脱性球囊栓塞治疗外伤性颈内动脉海绵窦瘘

目的：探讨可脱性球囊栓塞治疗外伤性颈内动脉海绵窦瘘的临床意义。方法：应用可脱性球囊经动脉途径栓塞治疗21例颈内动脉海绵窦瘘。结果：21例患者中,瘘口栓塞17例,闭塞颈内动脉4例,均治愈。其中瘘口栓塞后1例并发球囊早泄瘘口复发,经再次球囊栓塞成功。颈内动脉通畅率为80.9%。随访3-6个月未见复发。结论：可脱性球囊栓塞术是治疗外伤性颈内动脉海绵窦瘘的首选术式。     

Distal Baclofen Pump Catheter Migration Associated with Far‐Lateral Paraspinal Surgical Placement

Objectives. The increased rigidity and spasms implicit to patients being treated with baclofen provide a potential source of drug delivery system–related complications. Placement of the intrathecal catheter from the far‐lateral paraspinal approach has been advocated to avoid catheter fracture as previously reported with a midline approach. A thin fascial layer and increased muscle bulk laterally could increase motion of catheters placed in this position. The authors report on a series of patients found to have spinal catheter migration out from the thecal sac following a far‐lateral paraspinal surgical approach. Materials and Methods. The medical records of six consecutive patients who required revision of an intrathecal baclofen infusion system secondary to spinal catheter migration were included in this retrospective review. Each patient failed to respond to oral antispasmodic therapy and showed a positive response to a trial of intrathecal baclofen before initial pump implantation. Clinical notes and operative reports were reviewed. Results. All patients had a baclofen pump inserted with the intrathecal catheter placed through the far‐lateral portion of the paraspinal musculature entering above the lumbar vertebral pedicle. In all cases, the spinal catheter migrated and was found coiled outside of the thecal sac. In two patients, this occurred on two separate occasions. Mean time to catheter revision following implantation was 7 ± 2 months. Conclusions. Spinal catheter migration from the subarachnoid space can occur with intrathecal baclofen infusion systems. Alternative methods for spinal catheter placement warrant further study.     

Length-dependence of lymphatic phasic contractile activity under isometric and isobaric conditions

OBJECTIVE: Experiments were designed to determine if the effect of preload on the spontaneous contractile activity of rat mesenteric lymphatics would be different under isometric and isobaric conditions. METHODS: Isobaric protocols on cannulated, pressurized rat mesenteric lymphatics ( approximately 120 microm, ID) measured the effects of lumenal pressure on contraction amplitude, frequency, and rate of diameter change (dD/dt). Analogous protocols were conducted using a wire myograph to determine the effects of passive force (preload) on the characteristics of spontaneous, isometric force transients. Servo-control systems allowed responses to ramp or step increases in preload/pressure to be tested. RESULTS: Under isobaric conditions, contraction amplitude was maximal at the lowest pressure tested (1 cm H(2)O), and progressively declined with pressure elevation to 10 cm H(2)O. Changes in dD/dt followed a similar pattern. In contrast, contraction frequency progressively increased with pressure. Under isometric conditions, the amplitude of spontaneous force transients was maximal at preloads of 0.3-0.4 mN, with dF/dt following a similar pattern; the average peak amplitude was approximately 15% of the maximal active contractile force developed during agonist stimulation. The frequency of the transients increased with preload from 0.05 to 0.3 mN, and remained constant at higher preloads. The amplitude-frequency product, an estimate of lymphatic pumping ability, reached a maximum value at 0.4 mN in isometric vessels and at 6 cm H(2)O in isobaric vessels. CONCLUSIONS: Isometric and isobaric methods yielded qualitatively similar indices of spontaneous contractile activity. However, the ranges of amplitude and frequency changes were much greater under isobaric conditions (3- to 5-fold) than under isometric conditions (50-80%).     

Comparison of four proton pump inhibitors for the short-term treatment of esophagitis in elderly patients

AIM: To compare efficacy and tolerability of four proton pump inhibitors (PPIs) commonly used in the short-term therapy of esophagitis in elderly patients.METHODS: A total of 320 patients over 65 years with endoscopically diagnosed esophagitis were randomly assigned to one of the following treatments for 8 wk: (1) omeprazole 20 mg/d; (2) lansoprazole 30 mg/d; (3) pantoprazole 40 mg/d, or (4) rabeprazole 20 mg/d. Major symptoms, compliance, and adverse events were recorded. After 8 wk, endoscopy and clinical evaluation were repeated.RESULTS: Per protocol and intention to treat healing rates of esophagitis were: omeprazole = 81.0% and 75.0%, lansoprazole = 90.7% (P = 0.143 vs omeprazole) and 85.0%, pantoprazole = 93.5% (P = 0.04 vs omeprazole) and 90.0% (P = 0.02 vs omeprazole), rabeprazole = 94.6% (P = 0.02 vs omeprazole) and 88.8% (P = 0.04 vs omeprazole). Dividing patients according to the grades of esophagitis, omeprazole was significantly less effective than the three other PPIs in healing grade 1 esophagitis (healing rates: 81.8% vs 100%, 100% and 100%, respectively, P = 0.012). Pantoprazole and rabeprazole (100%) were more effective vs omeprazole (89.6%, P = 0.0001)and lansoprazole (82.4%, P = 0.0001) in decreasing heartburn. Pantoprazole and rabeprazole (92.2% and 90.1%, respectively) were also more effective vs lansoprazole (75.0%, P < 0.05) in decreasing acid regurgitation. Finally, pantoprazole and rabeprazole (95.2% and 100%) were also more effective vs lansoprazole (82.6%, P < 0.05) in decreasing epigastric pain.CONCLUSION: In elderly patients, pantoprazole and rabeprazole were significantly more effective than omeprazole in healing esophagitis and than omeprazole or lansoprazole in improving symptoms. H pylori infection did not influence the healing rates of esophagitis after a short-term treatment with PPI.     

Small bowel capsule endoscopy in 2007： Indications, risks and limitations

Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate, endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohn＇s disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool （which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions）.The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming, can overcome some limitations of capsule endoscopy. At the present time, in the majority of clinical conditions （i.e. obscure GI bleeding）, the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way （with capsule endoscopy） and to define and treat the lesions identified （with double balloon enteroscopy）.     

Evaluation of an osmotic pump for microdialysis sampling in an awake and untethered rat

The feasibility of using an osmotic pump in place of a syringe pump for microdialysis sampling in rat brain was investigated. The use of an osmotic pump permits the rat to be free from the constraints of the standard tethered system. The in vitro flow rates of a microdialysis syringe pump (set at 10.80 μl/h) and the osmotic pump (pump specifications were 11.35 μl/h) with no probe attached were compared, yielding results of 10.87 μl/h ± 1.7% and 10.95 μl/h ± 8.0%, respectively. The average of four flow rate experiments in vivo yielded R.S.D.s less than 10% and an average flow rate of 11.1 μl/h. Following the flow rate studies, in vivo sampling of neurotransmitters was accomplished with the osmotic pump coupled to a microdialysis probe implanted in the brain. Finally, after determination of basal levels of 3,4-dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), and 5-hydroxyindole-3-acetic acid (5-HIAA) in the rats, the rats were dosed with benserazide followed by l-3,4-dihydroxyphenylalanine (l-DOPA). The results from the dosing study showed at least a 10-fold increase in compounds in the l-DOPA metabolic pathway (DOPAC and HVA) and a slight or no increase in 5-HIAA (serotonin metabolic pathway.) These results indicate that the osmotic pump is a viable alternative to the syringe pump for use in microdialysis sampling.     

微量泵入胰岛素在控制重症急性胰腺炎高血糖及其强化治疗中的应用

目的：探讨微量泵入胰岛素在控制重症急性胰腺炎（SAP）高血糖及其强化治疗中的疗效。方法：将75例SAP高血糖患者随机分为两组,微量注射泵静脉注射胰岛素治疗（微泵组）和传统静脉滴注胰岛素治疗（传统组）。当血糖〉13．9mmol／L以上,开始剂量为0．1U／（kg·h^-1）的速度泵注或滴注胰岛素。每2h用血糖仪测指血糖,2h后血糖无下降,将剂量加倍。当血糖降至13．9mmol/L以下．根据VANDENBERGHE胰岛素强化治疗方案调整胰岛素用量。结果：微泵组控制血糖至13．9mmol／L所需时间、强化治疗中血糖波动值、ICU住院天数均明显低于传统组（P〈0．05）。结论：微量泵入胰岛素控制SAP高血糖较传统静脉滴注胰岛素能迅速、平稳、精确、有效、安全地降血糖．在血糖基本平稳后的强化治疗中能保持血糖稳定．减少了ICU住院天数。