胃内水球术治疗肥胖症47例分析

目的 探讨胃镜置入胃内水球术治疗肥胖症患者的疗效.方法 分析2010年7月至2011年5月间采用胃内水球术治疗的47例肥胖症患者的临床资料.结果 胃内水球术后6个月内,44例患者体质量有明显下降,减轻幅度在8.2～23.5 kg,平均15.4 kg;体质量指数下降3.2～6.4 kg/m2,平均4.7 kg/m2.术后并发症轻微,随访减肥效果良好.结论 胃内水球术是治疗肥胖症的有效方法,体质量减轻速度稳定,并且具有无创伤、痛苦小的特点.     

多学科合作,提高胰腺疾病的临床诊治水平

近年来，我国临床医学界同道对胰腺疾病的临床和实验研究给予了高度关注。目前内外科均已成立了相应的胰腺疾病学组，并创办了《胰腺病学》杂志，为我国胰腺病学的学科建设奠定了坚实的基础。2003年12月中华医学会消化病学分会在上海成功召开了全国胰腺疾病学术大会．在较大程度上     

不同阶段糖尿病胃运动障碍诊治对策

糖尿病患者常见胃运动障碍,表现为上腹胀、早饱、上腹不适、恶心、呕吐等症状以及胃排空延迟,胃排空延迟影响降血糖药的药代动力学,造成餐后血糖升高与降血糖药或胰岛素的血浓度高峰不匹配,进而影响血糖的控制与稳定。糖尿病不同阶段胃运动障碍表现形式不同。核素法是最常用的胃排空诊断方法。糖尿病胃运动障碍的处理包括饮食调节、促动力药以减轻症状、控制血糖,针对胃轻瘫的治疗包括胃电刺激、内镜下幽门注射肉毒杆菌毒素A、内镜下放置鼻胃空肠营养管或经皮内镜下胃（空肠）造瘘、外科手术等。     

Therapeutic Apheresis for Renal Diseases

Abstract: Plasma exchange is used frequently in renal diseases for the removal of the humoral components of immune responses. Various pathological circulating factors are recognized in primary and secondary renal diseases. Recent advances in medical technology have allowed a wider clinical application of plasmapheresis in the clinical management of a variety of conditions. However, the clinical efficacy of plasmapheresis in renal diseases is still controversial. In this article, we review the therapeutic use of apheresis in different renal diseases.     

Effect of Carbonated Water on Gastric Emptying and Intragastric Meal Distribution

Carbonated water has long been advocated torelieve dyspeptic symptoms, suggesting that it may altergastric motility via gastric distension. This studyaimed to determine the effect of carbonated water on gastric emptying of a radiolabeled mixedmeal in eight healthy volunteers. Meal emptying and itsdistribution within the stomach were assessed withcarbonated and still water in a crossover study.Emptying of both solid and liquid, including theduration of the lag phase, was identical for bothdrinks. However, the proximal stomach contained agreater proportion of solids (74 ± 7% vs 56± 8%, P < 0.05) and liquids (43 ± 5% vs 27 ± 4%, P < 0.05)with carbonated water as opposed to still water.Retention of the meal within the proximal stomach endedwith the lag phase and was likely related to proximaldistension. In conclusion, carbonated water did not alter overall gastricemptying but profoundly modified intragastricdistribution of the meal.     

Reproducibility and Intragastric Variation of Duodenogastric Reflux Using Ambulatory Gastric Bilirubin Monitoring

Duodenogastric reflux has long been considered to be important in the pathogenesis of many gastric disorders that exhibit regional variation within the stomach. Ambulatory gastric bilirubin monitoring is a new technique and, although extensively validated, reproducibility and gastric regional variation have not been specifically addressed. Fourteen patients with symptoms of gastroesophageal reflux and 12 healthy subjects underwent 24-h ambulatory gastric bilirubin monitoring with the bilirubin sensor in the upper stomach. Gastric bilirubin monitoring with two simultaneous bilirubin probes, one in the upper stomach and the other in the antrum, was performed on a separate occasion. Gastric bilirubin exposure in the initial and repeat studies showed a good correlation (R = 0.60, P < 0.01). Gastric bilirubin exposure in the upper stomach and the antrum showed a high degree of correlation (R = 0.90, P < 0.01). In conclusion, reproducible results are obtained with ambulatory gastric bilirubin monitoring and duodenogastric reflux does not exhibit significant regional variation within the stomach.     

Diagnostic and Therapeutic Challenges of Vasculitis

Systemic vasculitis can be a challenge to differentiate from other forms of vasculopathy. Because treatment for systemic vasculitis is disparate from that for other forms of vasculopathy, clinicians should strive for high diagnostic certainty. This review article aims to highlight the clinical, radiographic, and histologic clues to distinguish systemic vasculitis from mimics. Vasculitis should be considered in patients with preexisting conditions including autoimmune connective tissue diseases, multisystem manifestations, unexplained ischemic events, unusual radiographic findings, or signs of systemic inflammation. A multidisciplinary approach can be used among rheumatologists, vascular cardiologists, radiologists, and vascular interventionalists to raise diagnostic certainty in cases with large- and/or medium-vessel involvement. Recognition of cardiac manifestations, including myocarditis seen in forms of small-vessel vasculitis (eg, eosinophilic granulomatosis with polyangiitis) or coronary arteritis seen in forms of medium-vessel vasculitis (eg, polyarteritis nodosa and Kawasaki disease) is important owing to the associated mortality. Clinical phenotype, radiographic features, laboratory tests, and histology can help to differentiate vasculitis from noninflammatory vasculopathies and define the etiology of the vasculitis to help guide appropriate treatment. Various modalities of imaging can give clues to aid in diagnosis of vasculitis and can be considered in the context of physician preference and patient comorbidity. While conventional angiography can give important details regarding luminal anatomy and pressure gradients in medium- and large-vessel vasculitis, noninvasive imaging modalities such as computed tomographic angiography, magnetic resonance angiography, color Doppler ultrasound, and positron emission tomography/computed tomography are commonly used for both diagnosis and follow-up. Treatment for systemic vasculitis should be coordinated with an experienced rheumatologist.     

Relationship Between Low-Dose Aspirin-Induced Gastric Mucosal Injury and Intragastric pH in Healthy Volunteers

Background and Aims  

Gastric acid plays an important role in the pathogenesis of gastric mucosal lesions. We investigated whether aspirin-induced gastric mucosal injury might have any association with the intragastric pH.     

重视肝硬化腹水的规范性诊治

腹水是肝硬化最常见的并发症，一旦出现往往提示预后不良。建立肝硬化腹水的规范化诊治流程对改善肝硬化患者预后具有重大意义。准确评估腹水性质、重视血清腹水白蛋白梯度（SAAG）等腹水分类新指标的临床意义以及与传统检测方法的联合应用，是对肝硬化腹水患者进行规范诊治的前提。目前针对肝硬化腹水的三阶段综合治疗措施已较为明确，但其中一些细节问题仍存在争议。运用循证医学手段，进一步科学评价现有治疗方法，建立规范化诊疗体系：根据具体情况制定针对性强的个体化诊疗方案：重视评估新型利水剂的临床应用价值：深入探讨大量放腹水结合补充白蛋白治疗的必要性及其合适的剂量：规范自发性细菌性腹膜炎诊治方案，均是提高肝硬化腹水诊疗水平的关键。     

胃肠运动与中医脾胃病

本文介绍了胃肠运动的生理、生理调节、临床研究；中医对胃肠病的认识，中药与针灸对胃肠运动的影响等；同时提出了研究中的不足及展望。     

The Effects of Omeprazole on Intragastric pH,Intestinal Motility,and Gastric Emptying Rate

Background: The present study was designed to investigate whether omeprazole changes the characteristics and thereby the functions ascribed to fasting intestinal motility, postprandial motility, postprandial pH, and gastric emptying. Methods: Ten healthy subjects were investigated. The studies were performed after 10 days of treatment with 40 mg omeprazole daily/placebo. Duodenal pressures and intragastric pH were detected by strain-gauge transducers and a pH electrode attached to a miniature computer. The meal consisted of an omelette labelled with ^99mTc-sulphur colloids followed by 150 ml water labelled with ¹¹¹In-diethylenetriamine pentaacetic acid. Results: The difference in fasting intragastric pH between the two series was highly significant. The profile from the placebo series showed a relationship between phase activity and pH. The pH increased from phase I (median, 1.3; 95% confidence interval (CI), 0.9-1.6) to a maximum at 25% (1.8 (0.9-2.1)) and 50% (1.6 (1.1-3.8)) of cycle duration and decreased thereafter until the end of the cycle. The profile from the omeprazole series showed significantly higher values during the entire cycle but no relationship between phase activity and pH. Pretreatment with omeprazole was followed by a delay in gastric emptying of liquid at 30 min (64% (49%-66%) (omeprazole series) versus 78% (67%-83%); P &lt; 0.01) and solid at 180 min (71% (48%-86%) (omeprazole series) versus 96% (87%-100%); P &lt; 0.01). There was no significant difference in duration of postprandial motility (305 min (157-350 min) (omeprazole) versus 259 min (129-403 min)). Conclusions: Omeprazole eliminates the temporal relationship between intragastric pH and characteristics of the migrating motor complex and induces a delay in gastric emptying of both liquid and solid. A non-significant increase in duration of postprandial motility may represent a type-II error.     

治疗性血管新生的临床研究进展

因冠状动脉狭窄而致的缺血性心脏病是世界范围内致死的首要原因。基于大量动物试验的成功,治疗性血管再生已经步入了临床阶段。现对这方面的一些临床研究进行了总结,虽然临床上对血管再生的安全性有较多的肯定,但是临床上血管再生的结果却远不如动物实验理想。为进一步阐明冠心病时血管再生的治疗方法,还需要有大规模的随机、双盲、安慰剂对照试验。