Pre-operative neutralization of gastric acidity.

The incidence of Mendelson's syndrome in the four major Auckland hospitals is reviewed. The frequency of this condition was reduced following the pre-operative administration of magnesium trisilicate mixture in two hospitals. A trial was conducted in a third hospital and this showed that a 52 per cent incidence of highly acid gastric juice (pH less than 2.5) in patients prepared for elective surgery was reduced by administration of magnesium trisilicate mixture at the time of premedication. When the magnesium trisilicate mixture was given within the 30 minutes prior to induction of anaesthesia, the number of patients with highly acid gastric content fell to one per cent.     

Nonsurgical control of massive acute gastric mucosal hemorrhage with antacid neutralization of gastric content.

A simple and safe method of medical treatment for control of massive acute gastric mucosal hemorrhage is described. The procedure was developed from the observation that gastric HCl played a central role in peretuating the syndrome. The treatment consists in neutralization of the gastric acid with antacid to pH of 7.0. In preliminary observations of consecutive admissions, 19 of 20 (95 per cent) patients treated with this techinique stopped bleeding. The one remaining patient required surgery. There were no deaths. In contrast, 10 of 15 (66 per cent) patients stopped bleeding with conventional medical therapy. Four of the remaining patients required surgery to control the bleeding. One patient did not stop on medical management. All five (33 per cent) patients died.     

应激状态下胃黏膜损伤与胃排空及胃酸分泌的关系

目的研究胃黏膜损伤的确切原因和具体过程，为临床防治胃黏膜损伤、胃炎、胃溃疡及胃癌提供新的理论依据。方法以水浸-束缚应激（WRS）大鼠的方法，将144只Wistar大鼠随机分为9组，每组16只，A、B、C3组用放射性核素99m^Tc灌胃测定大鼠胃液相排空率；D、E、F3组采用手术清除胃内容物并幽门结扎测定胃酸分泌率；G、H、I3组为手术不清除胃内容物并幽门结扎，评估胃黏膜损伤溃疡指数（uI）；分析胃排空率、胃酸分泌和胃黏膜损伤之间的关系。结果随着WRS时间延长，大鼠胃排空速率明显下降，B组（WRS2h）和C组（WRS4h）的胃排空速率与A组（正常对照组）相比，差异均有统计学意义（P〈0．01）；C组与B组比较，差异有统计学意义（P〈0．01）。大鼠胃酸分泌受到显著抑制，E组（WRS2h）和F组（WRS4h）的胃酸分泌率与D组（正常对照组）相比，差异均有统计学意义（P〈0．01）；F组与E组比较，差异无统计学意义（P〉0．05）。胃黏膜损伤随着应激时间的延长而加重，清除胃内容物可以有效防治应激引起的胃黏膜损伤，手术对本实验无明显影响。B、C组与A组的胃黏膜损伤UI比较，差异有统计学意义（P〈0．01）；C组与B组比较，差异也有统计学意义（P〈0．01）；A、D、E、F、G组大鼠未出现胃黏膜损伤。H与E组比较，差异有统计学意义（P〈0．01）；I与F组比较，差异也有统计学意义（P〈0．01）；A、D、E、F、G组间比较，差异无统计学意义（P〉0．05）。H组与B组之间和I组与c组之间比较。差异有统计学意义（P〈0．01）。结论WRS可导致胃排空障碍、胃酸分泌减少和胃黏膜损伤。     

Evaluation of therapeutic efficacy in osteoporosis

Evaluation of the efficacy of osteoporosis treatments poses a major challenge for clinical investigators. This paper addresses the question of whether increases in bone mass induced by therapy for osteoporosis are sufficient to determine the efficacy of that therapy, or whether long-term fracture endpoint studies are required. Osteoporosis has been defined as a systematic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. This association between bone mass and fracture risk has been found to be stronger than other well-recognized risk factor associations, such as blood pressure and risk of stroke. Although fracture endpoint studies would provide confirmation of the benefit of osteoporosis therapy, such trials require that several thousand patients be studied for many years, making such studies impractical as a means for providing data for the approval of new therapies. Determination of increased bone mass may provide data that are just as useful in evaluating therapeutic efficacy. The use of bone mass as the primary efficacy endpoint for those therapies that are associated with normal bone quality is justified by the well-documented relationship between bone mass and fracture risk observed in several epidemiological studies.     

Esophageal emptying and acid neutralization in patients with symptoms of esophageal reflux.

Clearance of refluxed acid from the distal esophagus is due to bolus emptying and salivary neutralization of acid. We compared results of 24-hour pH monitoring with acid clearance tests (ACT) and radioisotope swallows (RIS) in 26 symptomatic patients to determine which of the components of acid clearance is better correlated with gastroesophageal acid reflux (GER). Seven of eight patients with GER had delayed esophageal emptying on RIS. Abnormal salivary clearance of acid was present in nine of 18 patients without GER, accounting for a high false-positive rate of ACT. Delayed esophageal bolus emptying, not deficient acid neutralization by saliva, is the predominant component of abnormal acid clearance in patients with GER. RIS is superior to ACT as part of the evaluation of reflux symptoms, and may prove to be a valuable screening test for this condition.     

Investigations of the efficacy of ascorbic acid therapy in cystinuria

Summary We investigated ascorbic acid therapy for cystinuria in a study of seven healthy control persons and seven cystinuric patients. The study lasted 9 days. During the first period, we collected 24-h urine specimens from all subjects on 3 consecutive days. Starting on day 4, all were given 5 g ascorbic acid/day for a period of 6 days. On the last 3 days, 24-h urine specimens were again collected. Quantitative amino acid determination was performed using an HPLC method described elsewhere. During ingestion of ascorbic acid, the mean excretion of cysteine by the control group increased from 134.1 to 159 mol/ day, whereas the excretion of cystine decreased from 107.1 to 82 mol/day. The corresponding values for the cystinuric patients increased from 352.4 to 452.1 mol/ day for cysteine and decreased from 4,131.6 to 3,663.2 mol/day for cystine. Thus, ascorbic acid seems to have only mild reducing properties in respect to cystine.     

Continuous gastric pH monitoring in children: the effect of gastric emptying on the measurement of gastric acid secretion.

Continuous gastric pH monitoring offers the opportunity to evaluate gastric acid secretion in humans without the need for collection of gastric aspirates. However, gastric emptying may be an important variable for the accurate measurement of gastric acid secretion using continuous gastric pH monitoring. We conducted an in vitro study (phase I) to evaluate the effect of gastric emptying on gastric pH. The in vitro study used a laboratory model in which continuous pH monitoring of a standard formula (Nutramigen, 100 mL) in a reservoir was performed while varying both the reservoir emptying rate (10% to 80%) over 1 hour and the amount of added acid (2 to 15 mEq/h: in vivo equivalent of 6 to 45 mEq/m2 BSA/h). An in vivo study (phase II) was then performed in 28 infants less than 6 months of age who had gastroesophageal reflux (GER) documented by 18- to 24-hour esophageal pH monitoring. At the end of esophageal pH monitoring, the pH electrode was advanced into the stomach for measurement of gastric pH continuously for 2 hours after a feeding of Nutramigen formula (300 mL/m2 BSA). Each patient also had a radionuclide gastric emptying study performed with the same volume of Nutramigen formula. In the in vitro model, the reservoir pH (% time pH less than 4) was proportional to the reservoir emptying rate only when acid was added at less than 15 mEq/h (less than 45 mEq/m2 BSA/h). Reservoir pH was independent of reservoir emptying rate when acid was added at 15 mEq/h (45 mEq/m2 BSA/h).(ABSTRACT TRUNCATED AT 250 WORDS)     

应进一步提高胃癌综合治疗的疗效

我国胃癌的发病率与病死率仍处于所有恶性肿瘤的前位。经过20余年的努力，我国众多的临床医疗中心已逐渐形成以手术为主并辅以化疗、放疗、生物免疫疗法的综合治疗模式。大多数临床报道显示，胃癌的整体疗效已有所改善．总体5年生存率达到30％左右，根治性手术后可提高至50％以上。但就胃癌外科综合治疗而言，[第一段]     

应用减量手术治疗无症状不可切除性晚期胃癌疗效Meta分析

目的 系统性评价减量手术在无症状不可切除性晚期胃癌中的有效性及安全性。方法 对PubMed、Cochrane图书馆、中国知网与万方数据库相关研究进行检索及筛选,检索期限为从建库至2021-05-12。纳入比较无症状的不可切除性晚期胃癌病人初始行原发灶切除或初始行全身治疗的研究。结果 最终共5项研究,其中包括随机对照研究1篇,回顾性研究4篇。累计样本量1717例,其中减量手术组共701例,非手术治疗组共1016例。Meta分析结果显示：减量手术组在1年、3年、5年生存率方面,相较非手术治疗组,均不能带来生存获益;在中位生存时间方面,减量手术组相较非手术治疗组长11.58个月;减量手术组围术期并发症发生率、病死率分别为15%、4%;约有3%的病人在非手术治疗过程中可能会出现原发灶并发症而需进行姑息性手术切除。结论 当前证据显示对于无症状的不可切除性晚期胃癌病人,原发灶切除的减量手术并不能获得生存获益。期待更多的高质量随机对照研究为临床实践提供更有力的证据支持。     

Evaluation of photodynamic therapy in gastric cancer

Twenty-eight patients with gastric cancer were treated by photodynamic therapy. Haematoporphyrin derivative was used as a photosensitizer and an argon dye laser as a light source. Histologically, all tumours were adenocarcinomas. On the basis of endoscopy, 17 cases were categorized as early-stage cancer and were classified as type IIc (10 lesions), Ha (three lesions), combined type IIc and type III (three lesions) and type I (two lesions). In 11 patients with advanced-stage cancer, endoscopy showed one case of Borrmann I, three of Borrmann II, six of Borrmann III and a single case of Borrmann IV. In the 17 patients with early-stage cancers (18 lesions), complete remission was obtained in 10 patients (11 lesions). Of 13 resected cancers complete remission was confirmed in six lesions on the basis of detailed histological examination of resected specimens. In the advanced stage tumours all 11 patients showed incomplete remissions. It is considered that an incomplete response in the early-stage cancers is due to insufficient light dosage because of the wide area of tumour, because the site of the lesion is anatomically difficult to photoradiate and because the invasion extends to the muscular layer and serosa.     

Cyclic AMP and gastric acid secretion in the dog

Canine gastric secretions were collected for acid and cyclic AMP assay at zero, 15, 30, 45 and 60 minutes during intravenous infusion of zero, 2.5 and 5.0 micrograms/kg/hr of pentagastrin. A resulting brisk acid response was not accompanied by an elevation of cyclic AMP content. It is thereby suggested that cyclic AMP may not be an obligatory intermediary for gastric acid secretion.     

Endogenous serotonin in the control of gastric acid secretion.

In three dogs with Heidenhain pouches (HP), gastric fistulas (GF), and duodenal cannulas, acidification of the duodenum with 0.1N HC1 (5 ml/minute) resulted in significant inhibition of GF output (preacidification, 8.66+/-0.58 mEq/30 minutes; postacidification, 5.47+/-0.66 mEq/30 minutes) and elevated peripheral venous blood levels of serotonin (basal, 226+/-64 ng/ml; peak, 521+/-168 ng/ml). Infusion of exogenous serotonin to comparable blood levels (basal, 208+/-38 ng/ml; mean postacidification, 571+/-153 ng/ml) resulted in similar GF inhibition (preacidification, 9.17+/-0.92 mEq/30 minutes; postacidification, 6.49+/-0.56 mEq/30 minutes). Per increment in peripheral blood serotonin of 1 ng/ml, endogenous serotonin inhibited 54.59+/-12.99 muEq/hour and exogenous serotonin inhibited 46.54+/-10.39 muEq/hour, p greater than 0.05. Neither endogenously released nor exogenous serotonin inhibited HP acid output. Using mesenteric venous infusions of serotonin, significant amounts of immunoreactive serotonin were found to escape hepatic inactivation; basal peripheral venous levels of serotonin, 233+/-103 ng/ml, increased to 455+/-127 ng/ml at 10 minutes. During release of endogenous serotonin, 92+/-21% of portal venous serotonin was bound to platelets; in contrast, during intraportal serotonin infusion, only 59+/-18% of serotonin was platelet bound.