Isolated Lower Esophageal Sphincter Relaxation as ``Wave-Suppressed' Secondary Peristalsis

Esophageal venting following air insufflation may occur by secondary peristalsis or by isolated transient lower esophageal sphincter relaxation (TLESR). To identify factors determining venting by these two mechanisms, we analyzed the responses to esophageal air insufflation in 4 infants and in 2 adults. We used a nine-lumen dual-Dent-sleeve manometric catheter with an air insufflation esophageal side hole, identifying swallowing by pharyngeal manometry or submental electromyography. The time from the venting lower esophageal sphincter relaxation (whether part of a secondary peristalsis or an isolated TLESR) to the next swallow (whether spontaneous, in the infants, or on command, in the adults) was characterized as ≥15 sec or <15 sec. Of the 25 evaluable trials, the subsequent swallow was ≥15 sec after the venting response in 9 instances and <15 sec afterward in 16 instances. Eight of the 9 trials with delayed swallows (≥15 sec) were vented by secondary peristalsis, whereas 11 of the 16 with early swallows (<15 sec) were vented by TLESR (X² p < 0.01). TLESRs may be induced by esophageal stimuli, in which case they may represent ``wave-suppressed' secondary peristaltic complexes.     

Effect of smooth muscle relaxant drugs on proximal human ureteric activity in vivo: a pilot study

Drugs are increasingly being used to promote stone passage in renal colic. Diclofenac, nifedipine and tamsulosin cause ureteric smooth muscle relaxation in vitro; however, in clinical trials nifedipine and tamsulosin promote stone passage whereas diclofenac has no apparent benefit. We adapted a ureteric pressure transducer catheter in an attempt to compare the human ureteric response to these drugs in vivo. The catheter was inserted into the contralateral ureter following ureteroscopy for stone disease. Contraction frequency, pressure and velocity measurements were recorded at 24 h. Each patient was randomly allocated to receive oral diclofenac, nifedipine or tamsulosin. Measurements were taken following drug administration. Eighteen patients (mean age 50 years) were recruited. Two patients were excluded intraoperatively and three required early removal of the catheter. Prior to drug administration, the mean number of contractions recorded was 0–4.1/min and the peak contraction pressure ranged from 11 to 35 mmHg. Conduction velocity ranged from 1.5 to 2.6 cm/s. Ureteric peristalsis persisted in all patients despite these drugs. Diclofenac and nifedipine produced inconsistent ureteric pressure responses but had little effect on contraction frequency. Tamsulosin significantly reduced ureteric pressure but had no effect on contraction frequency. There are many limitations associated with the use of ureteric catheters, however, they may provide some useful information when used to record the response to an intervention in the same patient. These preliminary results suggest a reduction in pressure generation may be the essential factor in the promotion of stone passage. More work is required but these drugs may work by preventing the increased, uncoordinated muscular activity seen in renal colic whilst maintaining peristalsis, thereby promoting stone passage.     

A novel videomicroscopic technique for studying rat ureteral peristalsis in vivo

Objectives  Existing techniques do not allow analyzing the fine movements of the ureteral wall during in vivo peristaltic contractions. A videomicroscopic technique has been developed to study the active mechanical displacements of the rat ureter. Methods  The middle portion of the ureter in a length of 16–18 mm was elevated from its base by microsurgical preparation, encased in a specific tissue chamber and continuously superfused with physiological saline. Contractions were recorded by videomicroscopy. A number of characteristic points on the surface were identified by the pattern of vasa vasorum. Their movements were analyzed in a coordinate system defined by the axial and radial directions of the segment. Identified surface points on the ureter moved along characteristic trajectory loops during contractile cycles. Results  In addition to the synchronized longitudinal and circumferential contractions, typical axial displacement cycles could be identified. Our observations demonstrate that longitudinal contractions might be more important in transporting the urine as thought earlier because of the axial tether of the ureter. Conclusions  (1) A longitudinal contraction ring preceding the circumferential one axially distends the distal segments. (2) Initial phase of the longitudinal contraction ring promotes bolus volume rearrangement toward the passive diameter dilation. (3) Longitudinal contraction with the maximum circumferential contraction ring just behind it helps pushing the urine bolus downward. (4) Ureteral segments proximal to the longitudinal contraction ring will be passively axially stretched which also helps their filling.     

阿那日五味散对实验动物胃肠功能影响的研究

目的：研究阿那日五味散对动物胃肠功能的影响。方法：采用胃排空、小肠推进、热板镇痛、扭体镇痛、盐酸型胃黏膜溃疡、醋酸型慢性胃炎模型,实验给药阿那日五味散。结果：阿那日五味散5g/kg、10g/kg能促进大鼠胃排空或小鼠推进功能,排空率为42％、34％,推进率为69％、74％;不同时间热板镇痛作用分别提高26％、45％、15％和32％、45％、37％;扭体镇痛抑制率分别为21％、34％;胃黏膜溃疡抑制率分别为27％、34％;慢性胃炎抑制率分别为40％、40％。结论：阿那日五味散具有促进胃肠运动,保护胃黏膜及镇痛作用。     

脑梗塞后特殊的磁共振成像表现

目的分析脑梗塞后MRI短T1信号的分布、表现特点,对其可能的机制进行初步的分析和预测.方法回顾性分析105例脑梗塞灶直径＞2cm的脑梗塞病人的MRI资料,扫描时病程在1d～120d范围内.结果105例脑梗塞病人中出现短T1信号者占48.57%(51/105).脑梗塞后短T1信号最早见于发病后3d内,高峰期为发病后7～30d,短T1信号的出现与病程呈正相关(r=0.41,P＜0.01).脑梗塞后短T1信号可发生在皮质区(59%)、皮质下区(31%)及基底节区(10%);表现为线状(49%)、斑片状(37%)和斑点状(14%).结论缺血性脑梗塞后短T1信号的出现与病程呈正相关,高峰期为病程第7d～30d;其产生的病理生理学机制可能为再灌注损伤、皮质层状坏死.     

Peristalsis abolishes the release of methionine-enkephalin from guinea-pig ileum in vitro

The release of methionine-enkephalin from superfused guinea-pig ileum has been demonstrated. Methionine-enkephalin, as measured by radioimmunassay, was shown to be released from tissues maintained at an intraluminal pressure of 0 cm water (resting conditions). Increased intraluminal pressure (5 cm water) induced peristalsis and abolished the release of methionine-enkephalin. These results provide further evidence that endogenous opioids may be involved in the modulation of contractile activity in the guinea-pig ileum.     

剖宫产术后综合应用微波治疗的观察与护理

目的　探讨微波对剖宫产术后产妇早进食、早泌乳的作用。方法　选取 2 76例剖宫产术后产妇 ,随机分为 2组 ,观察组应用微波于剖宫产术后 6h开始切口辐射治疗 ,7h进流质饮食 ,12h进半流质饮食 ,对照组不用微波 ,其余同观察组。结果　 2组疼痛分级情况有非常显著性差异 (χ2 =2 4 .5 5 ,P <0 .0 0 1) ,观察组给予镇痛药物明显低于对照组。术后体温≥ 38℃ 2次或 2次以上差异有非常显著性 (χ2 =7.0 ,P <0 .0 1) ,观察组肛门排气时间比对照组明显缩短 (t=7.6 9,P <0 .0 0 1) ,泌乳时间提前 ,泌乳量亦增加 (χ2 =7.31,8.10 ,73.98,P <0 .0 1,0 .0 0 1) ,2组切口愈合及硬结形成 ,皮肤和皮下脂肪裂开均有显著性差异(χ2 =5 .8,5 .4 1,P <0 .0 5 )。结论　剖宫产术后综合应用微波治疗对恢复产妇饮食、改善泌乳有积极作用     

腹部手术后胃管内注入番泻叶浸剂促进肠蠕动效果观察(附30例报告)

目的　探讨腹部手术后促进肠蠕动恢复的有效方法。方法　将 6 0例腹部手术后患者随机分为观察组 (30例 )和对照组 (30例 ) ,两组均给予开塞露肛注 ,在此基础上 ,观察组于胃管内注入番泻叶浸剂。用药后记录各组肠蠕动恢复及肛门排气时间。结果　观察组肠蠕动恢复及肛门排气时间均明显短于对照组 (P<0 .0 1)。结论　腹部手术后促进肠蠕动应首选胃管内注入番泻叶浸剂加肛注开塞露     

剖宫产术后促使产妇早进食早泌乳的护理研究

为促使剖宫产术后产妇早进食、早泌乳，满足母乳喂养的需要，选取360例剖宫产产妇，随机分为两组，实验组于剖宫产术后6h口服果导2片，7h进流质饮食，12h进半流质饮食；对照组于术后肛门排气后再进食。结果：实验组肛门排气时间比对照组明显缩短（P＜0．05），泌乳时间提前，泌乳量也增加（P＜0．05）。认为剖宫产术后适当刺激肠蠕动，对恢复产妇饮食、改善泌乳有积极作用。     

Considerations about pharyngeal manometry

Intraluminal manometry has the potential to provide relevant information for clinical or research studies of pharyngeal motor function. The usefulness of this information, however, depends on appropriate manometric instrumentation and technique. In this report, we discuss the instrumentation and techniques that are currently available for meaningful acquisition and interpretation of pharyngeal pressure phenomena. Sponsored in part by USPHS Grants AM 25731 and AM 07572.