Non-traumatic perforation of gastric ulcer in a hiatal hernia to the pericardium

A patient with ulcer in a hiatal hernia with perforation to the pericardial sac is reported. The symptoms and signs of non-traumatic perforation from esophagus or stomach to the pericardium or heart are described on the basis of a brief review of the literature. A prominent feature of our patient was long-standing pain in the left shoulder. We suggest that this symptom may be a warning of threatening pericardial perforation.     

巨大型食管裂孔疝的腹腔镜治疗现状

巨大型食管裂孔疝通常定义为食管裂孔超过6 cm或30%以上胃腔疝入胸腔内。腹腔镜手术治疗巨大型食管裂孔疝在临床逐渐被接受。对于术中同时实施胃底折叠术、正确处理短食管可减低复发率,减少并发症已获得临床共识。文章就巨大型食管裂孔疝腹腔镜治疗的临床特点、术中补片应用原则、胃底折叠术式选择及如何处理短食管问题作一综述。     

Observation of the upside-down stomach esophageal hiatal hernia in a cadaver

In the course of a cadaveric dissection in 2006, an upside-down stomach esophageal hiatal hernia was observed in a 91-year-old Japanese woman with kyphosis who had died of brain infarction. There are 31 clinical reports of upside-down stomach esophageal hiatal hernia, but the vascular system was not analyzed in any of these cases. In this specimen, most of the stomach except the pyloric region passed through the esophageal hiatus (approximately 40 mm in diameter) with the greater omentum and into the hernial sac located dorsal to the heart in the thoracic cavity. The greater omentum was raised on the ventral region in the hernial sac and spread toward the upper abdomen through the esophageal hiatus from the sac, without any adhesion in the abdominal cavity. The tail of the pancreas and the spleen were located near the esophageal hiatus. No abnormality was observed in the heart or lungs. The celiac trunk and its main branches were normal, but the left and right gastric arteries, the short gastric artery and the left gastroepiploic artery passed into the hernial sac through the esophageal hiatus. This specimen was classified as the sliding type of esophageal hiatal hernia. We consider the excessive kyphosis of the vertebral column to likely be associated with the formation of such a highly advanced hernia.     

生物补片修补食管裂孔疝的效果：1年随访

背景：尽管腹腔镜食管裂孔疝修补已取得良好的治疗效果,但对术中是否应该使用生物补片仍存在争议。 目的：分析生物补片修补腹腔镜食管裂孔疝的效果。 方法：回顾性分析2006-11/2009-06在复旦大学附属华山医院实施手术的57例食管裂孔疝患者临床资料,其中单纯膈肌脚缝合+Nissen胃底折叠24例(对照组),单纯膈肌脚缝合+Nissen胃底折叠同时行补片加强33例(实验组)。对比分析使用补片和未使用补片的治疗结果。 结果与结论：术后随访1年,实验组与对照组术后复发率、患者满意度、症状控制情况差异均无显著性意义(P > 0.05)。与对照组比较,实验组术中、术后并发症并未增加,同时手术时间及住院时间也未明显延长(P > 0.05)。短期随访结果说明补片加强修补食管裂孔疝是安全、有效的,但应严格掌握适应证。     

滑动性食管裂孔疝特定体位照影的临床观察与分析

食管裂孔疝主要是食管腹部、胃贲门部或胃底部经由薄弱的膈肌食管裂孔突入胸腔所致。它可以分为可复性和不可复性二种，不可复性食管裂孔疝分为短食管型、食管旁型及混合型，这种类型当病人口服硫酸钡剂后常规立位X线照影及胃镜易于查出，而可复性食管裂孔疝又称滑动性食管裂孔疝（简称滑疝）常规立位X线照影及胃镜检查不易发现。     

腹腔镜手术治疗小儿食管裂孔疝的效果分析

目的:探讨腔镜下食管裂孔疝修补+Nissen胃底折叠术治疗小儿食管裂孔疝的可行性及临床疗效。方法:回顾性分析2007年3月—2020年3月南京医科大学附属儿童医院小儿胸心外科收治的57例食管裂孔疝患儿的临床资料,其中男35例、女22例,年龄为2～97(17±4.17)个月。依据解剖分型标准,Ⅰ型46例,Ⅱ型7例,Ⅲ型4...     

Pathologic grief and its relationship to other psychiatric disorders.

The authors defined explicit criteria for the diagnosis of pathologic grief, and used the criteria to examine the relationship between pathologic grief and two disorders: major depression and anxiety disorders (panic and generalized anxiety), in a sample of 25 bereaved persons. Sixty-four percent of the sample met the criteria for pathologic grief. Pathologic grief was only significantly associated with major depressive disorder. It was also associated with high scores on dimensional measures of anxiety and depression. The most frequent complication of bereavement appeared to be an anxious subtype of major depressive disorder that occurred in conjunction with severe, prolonged separation distress.     

Dependence and its relationship to depression

Evidence is provided that dependence, either as a trait or a state, is closely related to depression. Theories to explain this fall into two broad categories: that some individuals make excessive demands for affection and become depressed when these are not met; and that some have persistently negative attitudes to life and an inclination to self-blame. These correspond with Blatt's (1974) two sources of depression, the ‘anaclitic’ and the ‘introjective’. Self-esteem forms a link in both theoretical approaches. It is proposed that there are three major components to dependence, which have been named affectional, ontological and deferential. The first corresponds with Bowlby's concept of anxious attachment and the psychoanalytic concept of the oral personality. The last is closely related to Beck's (1967) depression-prone person. The second, originally described by Laing (1965), is concerned with a poorly established identity and causes the individual to relate to another by the imperfect process of fusion. Its part in predisposing the person to depression is less well recognized. Excessive independence, or detachment, may be as maladaptive as dependence and the opposite of both dependence and independence is autonomy. The autonomous person is truly separate and yet able to form intimate relationships.     

Childhood cough variant asthma and its relationship to classic asthma.

BACKGROUND: In pediatrics, some patients with chronic cough who have no evidence of a causative disease are diagnosed as having cough variant asthma (CVA). The precise prognosis of infants and children with CVA, however, is still unclear. OBJECTIVE: To evaluate the relationship between CVA and classic asthma in childhood. METHODS: To diagnose CVA, we performed a methacholine inhalation challenge with use of a transcutaneous oxygen pressure (tcPO2) monitoring system in 100 children with chronic cough, and 75 children (45 boys and 30 girls; mean age, 5.7 years) were diagnosed as having CVA. These patients underwent follow-up monitoring for more than 3 years to ascertain whether classic asthma developed. For comparison, 53 age-matched children with classic asthma (30 boys and 23 girls; mean age, 5.6 years) and 30 age-matched control subjects (12 boys and 18 girls; mean age, 5.5 years) also participated in this study. Consecutive doses of methacholine were doubled until a 10% decrease in tcPO2 from the baseline was reached. The cumulative dose of methacholine at the inflection point of tcPO2 (Dmin-PO2) was considered to represent the sensitivity of tcPO2 to inhaled methacholine. RESULTS: After 3 years or more of follow-up assessments, 52 of the 75 patients answered our questionnaire. Of the responding patients, 28 had been diagnosed as having classic asthma. A significant difference was noted in the age at onset of CVA between the children in whom classic asthma developed (the asthma-developed group) and those in whom classic asthma did not develop (the asthma-free group). No statistically significant differences in Dmin-PO2 between the asthma-developed group and the asthma-free group or between the girls and the boys, however, were foun CONCLUSIONS: This study showed that 75% of children with chronic cough had CVA, that classic asthma developed in 54% of the children with CVA, and that it is not the severity of bronchial hyperresponsiveness in CVA but the age at onset of CVA that is a risk factor for the development of classic asthma in childhood CVA.     

The major histocompatibility complex and its relationship to allergic disease.

Two tests, the mixed leukocyte culture (MLC) and cell-mediated lympholysis (CML) tests, have been used as in vitro models of the in vivo allograft reaction. These tests have been applied to histocompatibility testing for transplantation as well as to assay of immune function. They involve the use of peripheral blood lymphocytes as "responding" cells in mixed leukocyte culture or as "stimulating" cells in the generation of a proliferative or a cytotoxic response. The proliferative events in MLC are primarily in response to LD antigens of the major histocompatibility complex; the cytotoxic cells use as their targets the SD antigens of that complex. A new method for defining the LD antigens, the primed LD typing (PLT) test, is based on in vitro sensitization of lymphocytes to certain LD antigens of the major histocompatibility complex and their subsequent restimulation with test cells.     

Visual reaction time and its relationship to neuropsychological test performance.

The purpose of this study was to investigate the relationship between simple and choice reaction time (RT) measures and neuropsychological test performance (as assessed by the Impairment Index of the Halstead-Reitan Neuropsychological Test Battery). Both median RT scores and intraindividual variability of RT scores were evaluated in three groups: impaired TBI, nonimpaired TBI, and normal controls. In all three groups, there was a statistically significant correlation between both reaction time measures and level of cognitive functioning. In addition, SRT, speed of information processing (as measured by CRT), and intraindividual variability of RT scores continued to be impaired in many brain-damaged individuals who, according to the Impairment Index, had fully recovered from their cognitive deficits. Median RT scores were better able to discriminate between impaired TBI patients and normal controls; but intraindividual variability of RT scores was better able to discriminate between nonimpaired TBI patients and normal controls. It was concluded that, by adding the two short RT tests to the neuropsychological test battery, more accurate predictions can be made about a patient's level of cognitive functioning and the nature of treatment needed for continued recovery.     

Malakoplakia of the testis and its relationship to granulomatous orchitis.

The chance finding of two cases of undiagnosed malakoplakia in the files of the Department of Pathology, Queen's University Belfast prompted a systematic study of all cases of inflammatory testicular and epididymal disease diagnosed in that department during a 43-year period from 1934 to 1977. A total of 71 cases was studied, and no additional example of malakoplakia was found. In the Belfast collection, there is one other example of testicular malakoplakia and therefore a total of three cases in 74 examples of inflammatory testicular and epididymal disease (4.3% incidence). In the series there were 10 cases of granulomatous disease (13.5%). The world literature on testicular malakoplakia has been reviewed, and typical and atypical features have been determined. Also a comparison has been made between testicular malakoplakia and granulomatous orchitis, and the relationship between these conditions is discussed.     

Thiocyanate inhibition of ATPase and its relationship to anion transport.

Adenosine triphosphatase activity not dependent on sodium or potassium but inhibited by thiocyanate is present in broken-cell homogenates of eel gill and rat kidney. This enzymatic property is predominantly associated with mitochondria, although thiocyanate-inhibited ATPase can also be detected in microsomes with little or no mitochondrial contamination as measured by the activity of the mitochondrial marker enzyme succinic dehydrogenase. When eels are transferred from fresh to salf water, thus increasing active outward transport of chloride across the gill, the thiocyanate-inhibited ATPase of gill microsomes does not change, though the activities of succinic dehydrogenase and Na-K-ATPase in gill homogenates are augmented. The thiocyanate-inhibited ATPase of homogenates of outer renal medulla does not differ from that of renal cortex, in contrast to Na-k-atpase which is higher in renal medulla than in cortex. The data do not support a role for thiocyanate-inhibited ATPase in active chloride transport by epithelial tissues.     

Chronic lymphocytic leukaemia and its relationship to other lymphoproliferative disorders.

Chronic lymphocytic leukaemia is a disorder with variable clinical presentation, but with constant and easily recognizable morphological features. The majority of cases are of B-cell lineage, the cells being characterized by IgM and IgD surface markers. In occasional cases monoclonal gammopathies with idiotypes identical to those of the SIg are produced. Some cases of CLL may be confused with Waldenstr?m's macroglobulinaemia. The clinical and morphological features of certain other lymphoproliferative disorders have been summarized. Finally, a progression of B-cell differentiation along an immunoexpressive spectrum has been described and the relative position of CLL defined. A correlation of cell morphology and function is possible in most cases. The possibility that CLL may terminate in an acute blastic crisis or histiocytic lymphoma is raised. It is emphasized that LPD include a wide range of diseases, some being non-malignant, others of questionable malignancy, and still others being frankly malignant. Clinical, morphological and immunological data are required for diagnosis in some cases.