上消化道纤维内窥镜在新生儿中的应用

对50例新生儿进行了52次上消化道纤维内窥镜检查,最小日龄18h;最小体重1900g。病史中有出生窒息及异常分娩史占大多数。虽然有10人无消化道症状,镜检中47人有不同程度胃粘膜损伤,以胃体、胃底部充血、糜烂、出血为主,一些病人伴有食道、胃窦及十二指肠病变。同时对新生儿胃镜检查的较高阳性率和检查本身的安全性及必要性进行了讨论。     

术中内镜检查对上消化道大出血的诊断意义

该文报告对上消化道大出血病人术中施行内镜检查28例，其中经口腔插镜10例，经胃肠切口置镜18例。发现出血病灶26例（92.9％）。经手术治愈25例，死亡3例。其中2例镜检时分不清真正出血原因，水后再度出血死亡，1例镜检时出现心跳骤停，水后昏迷死亡。文中就水中镜检的指征、方法、镜检与手术探查的关系及临床应用应注意的问题进行了讨论。     

SELECTIVE ENDOSCOPY IN MANAGEMENT OF INGESTED FOREIGN BODIES OF THE UPPER GASTROINTESTINAL TRACT: IS IT SAFE?

During a four-year period, 308 patients presented following ingestion of foreign bodies. Ingestion was accidental in 272 cases (88.3%) and deliberate in the remainder. Symptoms at presentation included dysphagia, odynophagia, nausea and vomiting, chest pain and pharyngeal discomfort. Sixty-eight patients were asymptomatic. A policy of expectant management and selective endoscopy was employed. Following initial assessment 202 patients (65.6%) were discharged without treatment, 30 (9.7%) of whom were later reviewed as outpatients and did not require admission. Forty-nine patients (16%) were admitted for treatment; 27 had oesophagoscopy, five bronchoscopy and two had foreign body extraction with direct laryngoscopy. In nine patients who were endoscoped, no foreign body was identified. Twenty-seven others were referred to the otorhinolaryngology service in another hospital. There were no deaths in the group and morbidity was 1.2%. We conclude that a policy of selective endoscopy is safe and effective in the management of patients following ingestion of foreign bodies.     

BLOOD FIBRIN IN UPPER GASTROINTESTINAL TRACT OBSTRUCTION

After high gastrointestinal tract obstruction the blood fibrin increases rapidly. The change is more marked in animals with obstruction of the cardiac end of the stomach. The rise in fibrin parallels closely the toxemia characteristic of such conditions. These results indicate that liver insufficiency cannot be the cause of death in such obstructions.     

十二指肠球部溃疡合并幽门螺杆菌感染时胃局部胃泌酸、生长抑素和前列腺素E_2含量的变化

该研究通过测定十二指肠球部溃疡合并幽门螺杆菌感染患者胃液、胃窦粘膜胃泌素、生长抑素、前列腺素E_2的含量,观察幽门螺杆菌根除后上述指标变化,并与浅表性胃炎患者对照,探讨幽门螺杆菌感染在十二指肠球部溃疡发病中的作用。     

THE IMPACT OF DIRECT ACCESS ENDOSCOPY,HELICOBACTER PYLORI NEAR PATIENT TESTING AND ACID SUPPRESSANTS ON THE MANAGEMENT OF DYSPEPSIA IN GENERAL PRACTICE

Direct access endoscopy services, Helicobacter pylori infection and more effective acid suppression therapy have influenced the management of dyspepsia in the past decade. Three hundred and ten GPs in south London were surveyed via postal questionnaire to determine the impact of these factors on the management of dyspepsia in general practice. Ninety-one per cent of GPs prescribed simple antacids as initial treatment for simple dyspepsia and referred only if symptoms did not improve. When acid suppresants were used, 41% used H₂ antagonists compared with 11% for proton pump inhibitors (p=0.0001). Risk factors for underlying malignancy were the most frequent reason for hospital referral at first consultation. Long outpatient waiting times result in about 90% of GPs choosing direct access endoscopy as the route of referral for all patients with dyspepsia, while only 36% would refer patients with sinister symptoms to direct access endoscopy if waiting times were similar to that of outpatients. H. pylori near patient testing did not seem to influence the management of dyspepsia in general practice.     

山东省医疗机构消化内镜消毒状况调查

目的了解医疗机构内镜室建设及消化内镜消毒效果现状,以加强医院内镜消毒与灭菌质量。方法通过现场调查和抽样检测方法,对省内10所医疗机构内镜室进行了监测和评价。结果所调查的10所医疗机构中,有7所设立了独立的清洗消毒室,配备了清洗消毒设备和内镜保存柜,有完整的清洗消毒记录。采集胃镜样本189份,消毒效果合格率为75.13%;三级医院胃镜消毒效果合格率为87.88%,二级医院胃镜消毒效果合格率为61.11%。采集肠镜样本69份,消毒效果合格率为66.67%,其中三级医院合格率77.41%,二级医院合格率为57.89%。结论山东省部分医疗机构消化内镜消毒质量总体偏低,硬件建设达标率只有70%,应加强内镜消毒监督管理,确保内镜消毒质量。     

兰索拉唑三联疗法根治胃幽门螺杆菌的疗效观察

81例经胃镜证实的HP阳性十二指肠溃疡患者，随机分成二组分别接受兰索拉唑三联或二联疗法根除HP治疗。服法：三联组兰索拉唑30mg，每日2次，阿莫西林0．5g及甲硝唑0．4g，每日3次；二联组兰索拉唑服法同上，阿莫西林0．5g,每日4次。疗程均为10d.结果：三联组根除率为95％（38／40），高于二联组80．5％（33／41）（P＜0.05）；溃疡愈合率分别为87．5％及87．8％；副反应发生率分别为15％（6／40）及4．9％（2／41），P＞0．05。结果表明：兰索拉唑三联疗法具有症状缓解迅速、HP根除率高、副反应轻、依从性好等优点，是一种较理想的根除HP治疗方案。     

POPULATION PHARMACOKINETICS OF PHENYTOIN FROM ROUTINE CLINICAL DATA IN JAPAN

Routine clinical pharmacokinetic data collected from out-patients who received phenytoin were analysed to estimate population pharmacokinetic parameters. There were 505 steady-state phenytoin concentrations and associated dosage rates (mg/day) from 220 out-patients. The data were analysed using NONMEM, a computer program designed for population pharmacokinetic analysis that allows pooling of data from many individuals. The influence of weight on the maximum elimination rate (Vm) and age on the Michaelis-Menten constant (Km) or the influence of dosage form on the bioavailability (F) of phenytoin were investigated. The Vm and Km of a 60-kg adult out-patient were estimated to be 369 mg/day and 3.67 mg/l, respectively. The parameter of a power function of weight was estimated to adjust Vm for body size. The best function adjusts Vm in proportion to weight to the 0.55 power. The Km for patients less than 15 years old was 16% less than that for adults. When the F of phenytoin is assumed to be 100% in the patients prescribed a tablet, the F value in the patients prescribed a powder was 89.5%.     

消化性溃疡200例胃粘膜幽门螺杆菌检测分析

应用快速尿素法及组织切片染色对200例消化性溃疡（Pepticulcer，PU）病人的胃窦粘膜进行幽门螺杆菌（He－licobacterPylori，HP）检测。结果显示两种检测方法符合率高达95．14％，HP阳性率仅占1／3。PU活动期病人多为中青年，冬季多发，但HP感染并无明显季节性，提示HP并非PU发病的唯一直接因素。     

DOES HAEMOSTATIC THERAPY IMPROVE THE PROGNOSIS IN UPPER GASTROINTESTINAL BLEEDING?

SUMMARY A study was conducted of 816 patients with peptic ulcer haemorrhage, comparing outcome before and after the introduction of endoscopic therapy. The control group comprised 505 patients admitted with bleeding due to benign peptic ulcer over a 5-year period before endoscopic therapy, and 311 patients after introduction of endoscopic therapy were studied prospectively. The two groups were well matched for age, sex, shock, endoscopic findings and use of ulcerogenic drugs. The introduction of endoscopic therapy was associated with a reduction in surgical intervention and mortality rates for gastric and duodenal ulcer. The beneficial effects of endoscopic therapy appear to be due to a reduction in the need for surgical intervention in patients with an ulcer base visible vessel. The authors suggest that endoscopic injection therapy may result in an improved outcome from peptic ulcer haemorrhage. Adrenaline injection treatment seems to be the treatment of choice in view of its simplicity, low cost and availability.     

胃癌组织Survivin蛋白表达及其与HP感染关系

目的探讨Survivin蛋白在胃癌中的表达及其与幽门螺杆菌（HP）感染之间的关系。方法应用免疫组化方法检测70例胃癌及癌旁组织标本Survivin蛋白的表达,Warthin-Starry染色法检测胃癌组织中HP感染情况。结果胃癌组织中Survivin阳性表达率74.3%,癌旁组织为41.4%,胃癌组织中Survivin的表达强度明显高于癌旁组织（Z=5.33,P〈0.05）。Survivin蛋白表达与病人性别、Borrmann分型无关（P〉0.05）;而其表达强度与胃癌分化程度、浸润深度、临床分期、淋巴结转移有关（Hc=-4.52～14.70,P〈0.05）。Survivin蛋白表达强度与HP感染有关（Z=2.46,P〈0.05）。结论Survivin蛋白的表达与胃癌发生、演进有关;HP感染可增强胃癌Survivin的表达强度。     

幽门螺杆菌和端粒酶在胃癌发生中的相关性研究

目的 :探讨幽门螺杆菌 (HP)、端粒酶与胃癌的关系 ,特别是胃癌发生中HP与端粒酶的相关性。方法 :将病例分为胃癌、癌前病变和慢性浅表性胃炎 3组 ,用快速尿素酶法、W -S染色法检测HP ,用ELISA法检测血清CagA -HPIgG浓度 ,以判断CagA的有无 ;分别对胃癌取胃癌组织、癌旁组织和正常胃粘膜组织 ,用PCR -ELISA法检测端粒酶活性。 结果 :HP、CagA -HP感染率在 3组间有差异 ( P <0 0 5 ) ,胃癌前病变组和胃癌组HP、CagA -HP感染率高于慢性浅表性胃炎组 ( P <0 0 1) ,癌前病变组与胃癌组间HP、CagA -HP感染率无差异 (P >0 0 5 )。胃癌组织端粒酶阳性率高于癌旁和正常组织 (P <0 0 1)。有 HP感染的胃癌与无HP感染者比较 ,端粒酶阳性率无显著差异 (P >0 0 5 ) ,CagA -HP感染的胃癌其端粒酶阳性率与CagA阴性HP感染者比 ,也无差异 (P >0 0 5 )。结论 :HP、CagA -HP和胃癌的发生有关 ,可能在胃癌发生的起始阶段起作用 ,活化的端粒酶促进了胃癌的发生、发展 ,胃癌发生过程中 ,HP、CagA -HP感染对端粒酶激活无直接影响。     

CONTROVERSY AND CONSENSUS IN THE MANAGEMENT OF UPPER GASTROINTESTINAL DISEASE IN PRIMARY CARE

Approximately 5% of all primary care consultations in the UK are for upper gastrointestinal (GI) diseases, the most common of which is dyspepsia, with a prevalence of between 25 and 50% in the western world. The exact definition of dyspepsia is elusive, which has resulted in confusion about diagnosis and treatment, highlighting the need for management guidelines. The International Gastro Primary Care Groups (IGPCG) has developed, by consensus, practical guidelines to help GPs manage patients with upper GI symptoms. After a detailed history is taken, alarm symptoms identified and organic disease excluded, the predominant symptom should be identified. This strategy, as outlined in the IGPCG upper GI disease management plan, can help the GP in the selection of the most appropriate treatment for each patient. This plan is flexible enough to be used in a wide variety of healthcare systems and will evolve as new evidence becomes available.     

微量14碳-尿素呼气试验诊断幽门螺杆菌的研究

目的：评估微量碳－悄素呼气试验（１４Ｃ－ＵＢＴ）诊断幽门螺杆菌（ＨＰ）感染的可靠性。方法：对９０例因上消化道不适而进行胃镜检查的患者,于胃窦部取多块活检标本进行组织学粘膜涂片涂色和快速尿素酶试验,以商定是否感染ＨＰ,并作１４Ｃ－ＵＢＴ。结果：１４Ｃ－ＵＢＴ的敏感性、特异性及准确性是与组织这以及原素酶方法检测ＨＰ的检测结果相比较而得到的。１４Ｃ－ＵＢＴ的敏感性为９８．０４％,准确性为９７．７８％,特     

Hp菌株cagA、picB基因与胃粘膜IL-8表达、消化性溃疡关系的初步研究

目的 :初步探讨Hp菌株cagA、picB基因表达与胃粘膜IL - 8分泌 ,消化性溃疡发病的关系。方法 :采用分离培养技术行Hp培养 ;PCR扩增技术检测cagA、picB基因表达 ,ELISA法检测胃窦部IL - 8表达水平。结果 :消化性溃疡患者胃窦部粘膜IL - 8表达水平显著高于慢性胃炎患者 (t=15 .5 2 ,P <0 .0 1) ;消化性溃疡患者中cagA / picB 菌株感染率显著高于慢性胃炎患者 (χ2 =9.99,P <0 .0 1) ;cagA / picB 菌株感染者胃窦粘膜IL - 8表达水平显著高于cagA-/ picB-菌株感染者 (t=5 .43,P <0 .0 1)。结论 :IL - 8在Hp相关性消化性溃疡中起重要作用 ;cagA / picB 菌株感染可能与消化性溃疡的发病有关     

EFFICACY OF NIZATIDINE,CLARITHROMYCIN AND BISMUTH SUBCITRATE THERAPY FOR HELICOBACTER PYLORI ERADICATION IN DUODENAL ULCER PATIENTS — A PRELIMINARY REPORT

SUMMARY The triple combination of nizatidine, clarithromycin, and bismuth subcitrate resulted in an ulcer healing rate of 98% and an H. pylori eradication rate of 90%. Corresponding ‘intention-to-treat’ figures were 92% and 84%, respectively. These results suggest that further studies, shorter in duration, using lower dosages, and possibly testing other combinations with a double-blind methodology, are required.     

HELICOBACTER PYLORI ERADICATION - COMPARISON OF THREE DRUG REGIMENS AND SYMPTOMATIC ASSESSMENT IN DUODENITIS AND ANTRAL GASTRITIS

Helicobacter pylori (Hp) eradication in peptic ulcer disease is associated with a greatly reduced recurrence rate. The optimal drug regimen for Hp eradication remains uncertain. It is also unclear if eradication of Hp in duodenitis and antral gastritis improves symptoms. The aims of this study were to compare the efficacy of three drug regimens in the eradication of Hp and to assess if Hp eradication improved symptoms in patients with duodenitis and antral gastritis. Patients (n=79) found to have duodenal ulcer, duodenitis and/or antral gastritis with a positive urease test (CLO) at endoscopy were allocated to one of three regimens: A. omeprazole 20 mg b.d. and clarithromycin 500 mg t.d.s. for two weeks (n=27), B. De-Nol 240 mg b.d. for four weeks, metronidazole 400 mg t.d.s. and amoxicillin 500 mg t.d.s. for one week (n=26), and C. omeprazole 20 mg b.d. and amoxicillin 500 mg t.d.s. for two weeks (n=26). In conclusion, traditional ‘triple’ therapy with bismuth and two antibiotics achieved the highest Hp eradication rate and was best tolerated. Recolonisation with Hp was uncommon after eradication. Dyspeptic symptoms improved with Hp eradication in duodenitis and antral gastritis.