紧急经皮冠状动脉腔内成形术与溶栓治疗急性心肌梗死的比较

目的　比较紧急经皮冠状动脉腔内成形术 (PTCA)治疗急性心肌梗死 (AMI)与尿激酶静脉溶栓治疗AMI的临床疗效及安全性。方法　在 77例AMI患者中 ,2 8例患者接受紧急PT CA治疗 ,49例患者接受尿激酶静脉溶栓治疗。结果　紧急PTCA组中梗塞相关血管开通 2 6例 ,开通率为 92 .9% ,尿激酶静脉溶栓组中梗塞相关血管再通 2 8例 ,再通率为 5 7.1% ,两组比较差异有显著性 (P <0 .0 5 )。紧急PTCA组住院期间心脏事件发生率为 7.1% ,尿激酶静脉溶栓组为2 0 .4% ,两组比较差异有显著性 (P <0 .0 5 )。紧急PTCA组住院时间为 (11.5± 4.2 )天 ,尿激酶静脉溶栓组为 (19.7± 5 .6)天 ,两组比较差异有显著性 (P <0 .0 5 )。结论　紧急PTCA与尿激酶静脉溶栓治疗AMI时 ,前者的开通梗塞相关血管及降低住院期间心脏事件发生率优于后者 ,而且住院时间明显缩短。     

急诊冠状动脉腔内成形术与溶栓治疗急性心肌梗塞的临床分析

目的　探讨急诊冠状动脉腔内成形术 (PTCA)对急性心肌梗塞 (AMI)的临床疗效。方法　对 5 2例AMI患者行急诊PTCA治疗 (PTCA组 ) ,5 8例AMI患者行溶栓治疗 (溶栓组 ) ,比较两组住院和随诊期间的情况。结果　PTCA组住院期间死亡 3例 ,抢救成功率为 94 2 % ,平均住院天数为 14 6天(9 5± 4 2天 ) ,左室射血量数 (LVEF)为 45 5 %± 4 3% ;随诊 2～ 18个月 ,心绞痛发作 3例 ,择期再次PTCA 3例。溶栓组住院期间死亡 8例 ,抢救成功率为 86 2 % ,平均住院天数为 2 6 4天 (17 2± 7 5天 ) ,LVEF为 37 6 %± 6 2 % ;随诊 2～ 18个月 ,心绞痛发作 17例 ,行择期PTCA 17例。结论　急性心肌梗塞急诊PTCA可即时开通梗塞相关血管 (IRA) ,大大降低AMI的住院死亡率 (P <0 0 1) ,缩短住院天数 (P <0 0 1) ,有效保护心脏功能 (P <0 0 5 )。     

心肌灌注显像对经皮冠状动脉腔内成形术后的远期预后价值

目的　评估99mTc MIBI运动 静息心肌灌注显像对经皮冠状动脉腔内成形 (PTCA)术后患者的远期预后价值。方法　对 181例接受PTCA术或PTCA +支架术后行99mTc MIBI运动 静息心肌灌注显像的患者 ,随访 ( 36± 30 )个月。结果　根据心肌显像结果将患者分为三组 :心肌显像正常组 (n =10 1) ;心肌梗死组 (n =39) ;心肌缺血组 (n =41)。随访期间 ,如发生急性心肌梗死和死亡为恶性心脏事件 ,再次血运重建术和不稳定性心绞痛为良性心脏事件。共 37例 ( 2 0 4 % )患者发生心脏事件 ,其中心肌缺血组心脏事件发生率为 70 7% ( 2 9 4 1) ,明显高于心肌梗死组的 12 8% ( 5 39) ( χ2 =2 7 4 3 ,P <0 0 0 1)和心肌显像正常组的 3 1% ( 3 10 1) ( χ2 =72 87,P <0 0 0 1)。心肌缺血组的恶性心脏事件发生率为 7 3% ,高于正常组的 0 % ( χ2 =4 4 3 ,P <0 0 5 )。在心肌显像后 1年、3年、5年和 10年的无心脏事件率在心肌缺血组分别为 5 0 5 % ,34 4 % ,17 2 %和 17 2 % ;在正常组分别为 98 0 % ,96 4 % ,96 4 %和 96 4 % ( χ2 =96 32 ,P <0 0 0 1)。Cox多元线性回归分析显示运动显像的总积分(SSS)是预测PTCA术后发生恶性心脏事件的惟一独立危险因子 (RR 1 12 ,95 %CI:1 0 3～ 1 2 0 ,P =0 0 0 3)。运动 静     

梗死相关动脉自发再通后即刻和择期经皮冠状动脉腔内成形术的比较研究

目的　比较研究梗死相关动脉自发再通 (SR)后即刻和择期经皮冠状动脉腔内成形术的临床结果。方法　选择 1996年 1月至 2 0 0 1年 3月的 118例SR患者为研究对象 ,其中TIMI 2级血流患者 36例中 2 4例施行了即刻PTCA ,12例在梗死后 7～ 14d施行了择期PTCA ;TIMI 3级血流患者82例 ,其中 4 5例施行了即刻PTCA ,37例施行了择期PTCA。结果　发病 2周后 ,TIMI 2级血流两组的死亡率、再梗死率以及TIMI 3级血流两组的死亡率、再梗死率、复发缺血事件发生率差异无显著性 ,但TIMI 2级血流择期PTCA组的复发缺血事件发生率显著高于即刻PTCA组 (1 2 4vs 4 12 ,P =0 0 34)。此外 ,择期PTCA组肝素或低分子肝素的应用显著多于即刻PTCA组 (4 2 4vs 11 12 ,3 4 5vs34 37,P <0 0 0 1)。 6个月随访时 ,TIMI 2级血流择期PTCA组充血性心力衰竭发生率较即刻PTCA组有增高的趋势 (1 2 4vs 3 12 ,P =0 0 98) ,而且择期PTCA组的左室射血分数显著低于即刻PTCA组[(6 1 4± 6 3) %vs(4 3 8± 5 4 ) % ,P =0 0 3]。结论　发生SR的患者进行即刻PTCA的临床结果优于择期PTCA ,同时可以降低住院总费用 ,减少患者痛苦。     

冠状动脉介入或联合溶栓治疗急性心肌梗死的临床研究

目的探讨急诊冠状动脉介入治疗 (PCI)或联合溶栓治疗对急性心肌梗死 (AMI)的临床疗效。方法　对 3 3例AMI患者行直接PCI治疗 (PCI组 ) ,3 6例AMI患者在溶栓治疗的同时行直接PCI治疗 (溶栓 +PCI组 ) ,42例AMI患者行溶栓治疗 (溶栓组 ) ,比较各组住院和随诊期间的情况。结果　PCI组住院天数为 (9.3± 4.1)天 ,左心室射血分数 (LVEF)为 (4 5 .1± 4.2 ) % ;随诊期间 ,心绞痛发作 2例 ,择期再次PCI 2例。溶栓 +PCI组住院天数为 (9.2± 4.0 )天 ,LVEF为 (4 7.2± 4.1) % ;随诊期间 ,心绞痛发作 1例 ,择期再次PCI 1例。溶栓组住院天数为 (14 .0± 7.3 )天。LVEF为 (4 1.8± 6.4) % ;随诊期间 ,心绞痛发作 15例 ,择期PCI 14例。结论　AMI直接PCI或溶栓 +PCI可降低AMI的住院死亡率 (P <0 .0 1) ,缩短住院天数 (P <0 .0 5 ) ,有效保护心脏功能 (P <0 .0 1)。     

急诊冠状动脉介入治疗与静脉溶栓治疗急性心肌梗死的疗效对比分析

目的　比较急诊冠状动脉介入治疗 (PCI)与静脉溶栓治疗对急性心肌梗死 (AMI)患者近期的临床效果。方法　 2 18例ST段抬高的急性心肌梗死患者 ,10 1例患者接受静脉溶栓治疗 (溶栓组 ) ,117例接受急诊PCI治疗 (PCI)组 ,比较接受两种治疗方法患者住院期间的临床结果。结果　溶栓组梗死相关血管 (IRA)再通率为 70 4 % ;急诊PCI组IRA再通率为 98 8% ;30d时左室射血分数 (EF)溶栓组为5 6 1± 11 2 ,急诊PCI组为 6 0 2± 9 1,差异有显著性 (P <0 0 5 ) ;病死率分别为 8 9%和 3 4 % ,两组间差异有显著性(P <0 0 5 )。分析溶栓再通组与急诊PCI组的临床疗效 ,前者再发梗死、发生心肌缺血事件和心力衰竭 ,比率明显高于急诊PCI组 (30 7%vs 15 3% ,P <0 0 5 )。溶栓组平均住院天数为 15 8d[(12 3± 6 8)d],PCI组平均住院天数为 10 2d[(7 2± 3 1)d],两组间差异有显著性 (P <0 0 5 )。结论　急诊冠状动脉介入治疗与静脉溶栓治疗急性心肌梗死患者对比 ,前者可充分有效地开通IRA ,降低死亡率 ,能更好地改善患者心功能 ,缩短住院时间。     

视频密度阶差评价急性心肌梗死者急诊冠状动脉介入治疗前后心肌微灌注的临床研究

目的:结合校正的TIMI记帧计数(CTFC),探讨视频密度阶差(VDS)在评价急性心肌梗死者急诊冠状动脉介入治疗(PCI)前后心肌微灌注中的应用价值。方法:计算120例急性心肌梗死行急诊PCI患者PCI术前后的CTFC和VDS,并统计患者急诊PCI前后的TIMI分级、左室射血分数、住院期间的心脏不良事件。结果:急诊PCI术前后VDS为10.2±3.8、20.8±7.6,术后显著高于术前(P<0.05);PCI后CTFC显著低于术前[(30.3±8.6)∶(22.4±5.6),P<0.05]。急诊PCI后:VDS明显低于冠状动脉造影正常者(P<0.05),CTFC与冠状动脉造影正常者差异无统计学意义(P>0.05)。VDS是住院期间心脏不良事件发生的独立相关因素。VDS≤20者的住院期间心脏不良事件发生显著高于VDS>20者和CTFC≤30者(P<0.05)。结论:VDS评价急性心肌梗死行急诊PCI者的心肌微灌注时较CTFC敏感性更高,可作为急性心肌梗死患者住院期间心脏不良事件发生的一个独立的预测指标。     

血栓抽吸导管在急性心肌梗死恢复期择期经皮冠状动脉介入治疗中应用的临床研究

目的:观察和分析ZEEK血栓抽吸导管在急性心肌梗死恢复期择期经皮冠状动脉介入治疗(PCI)中应用的有效性及安全性,评价其对心肌组织灌注及心脏功能的作用。方法:2007-07至2009-12入选急性心肌梗死恢复期行择期PCI患者共61例,其中男性41例,女性20例,年龄36～82(59.27±10.56)岁。将患者随机分为两组,使用ZEEK血栓抽吸导管的31例患者为抽吸组,未使用抽吸导管而行常规PCI的30例患者为非抽吸组,比较两组间的基础临床特征、心肌组织灌注水平和术后1周由超声心动图检查测定的心脏功能以及住院期间主要心脏不良事件。结果:两组基础临床情况差异无统计学意义。抽吸组术后心肌梗死溶栓治疗临床试验(TIMI)3级血流发生率明显高于非抽吸组(93.55%比56.67%,P=0.001);抽吸组TIMI2级血流(慢血流)、TIMI0～1级血流(无复流)发生率明显低于非抽吸组(分别为6.45%比26.66%,P=0.013;及0比16.67%,P=0.024);抽吸组校正的TIMI帧数明显少于非抽吸组[(27.94±5.80)帧比(39.20±5.33)帧,P=0.000];抽吸组术后1周由超声心动图测定的左心室射血分数明显高于非抽吸组(0.56±0.10比0.47±0.09,P=0.000),E峰/A峰1的比率明显低于非抽吸组(16.13%比46.67%,P=0.017),左心室舒张末期内径明显小于非抽吸组[(5.05±0.39)cm比(5.92±0.47)cm,P=0.000];差异均有统计学意义。术后住院期间两组患者均未出现包括心源性死亡、再发心肌梗死的主要心脏不良事件。结论:在急性心肌梗死恢复期择期PCI中应用ZEEK血栓抽吸导管是安全有效的,抽吸导管能有效清除冠状动脉内未完全机化的血栓,改善心肌组织灌注,并且能改善术后心脏功能,而不增加主要心脏不良事件的发生率。     

纤溶酶预处理对择期冠脉介入治疗的临床研究

目的观察术前应用纤溶酶对急性心肌梗死择期经皮冠状动脉介入治疗(PCI)患者的临床疗效。方法将130例超过急诊PCI时间窗(12 h)的急性心肌梗死患者随机分为对照组66例和试验组64例。2组患者均接受常规治疗且均在起病8~12天成功接受PCI手术。治疗组在此基础上予以纤溶酶治疗。比较两组临床基线情况、PCI术中心肌梗死溶栓治疗临床试验(TIMI)血流分级、校正的TIMI帧数(CTFC)、无复流/慢血流情况、心脏彩超的变化及随访心血管事件的发生。结果与对照组相比,纤溶酶组术中梗死相关动脉(IRA)开通后TIMI3级血流比例明显增加(分别为92.2%vs 63.6%;P均0.05),CTFC明显改善[(21.0±5.1)帧vs(30.8±4.1)帧,P0.001],试验组术中无复流的发生率为5%明显少于对照组的14%;术后6个月心脏功能改善,主要心血管不良事件减少(P0.05)。结论对超过急诊PCI时间窗的急性心肌梗死患者术前进行纤溶酶预处理,可减少术中无复流/慢血流的发生率,改善心肌灌注,改善心功能且减少术后心血管不良事件发生率。     

肌红蛋白系列测定对两种不同心肌血流再通疗效的评价

目的 :探讨肌红蛋白时间含量测定对静脉溶栓与直接经皮腔内冠状动脉成形术 (PTCA)并安放支架对血流再通效果的评价 ,并比较不同再通方式的梗死面积差异。方法 :测定 15例静脉溶栓再通急性心肌梗死(AMI)患者 (溶栓组 )、5例直接PTCA并安放支架后TIMI血流达 3级患者 (介入组 )血流再通前 ,再通后 4、8、12、16h肌红蛋白含量并以ST段平方面积测定再通前及再通后 8、12h两组的梗死面积大小。结果 :肌红蛋白系列含量测定诊断AMI的敏感性为 10 0 %。不同溶栓方法在血流再通前肌红蛋白含量均显示明显增高。再通后 4h ,两组的肌红蛋白含量迅速上升直达高峰。介入组比溶栓组含量有所增高 [(6 80 .0 0± 99.10 )∶(372 .75± 6 7.80 )μg/L]。随后的肌红蛋白系列测定表现出成倍递减并与时间呈线性相关 (r =0 .78,P <0 .0 0 1)。ST段平方面积测定显示 ,介入组梗死面积明显小于溶栓组 [(2 2 .5± 15 .1)∶(5 8.2± 2 0 .0 )mm2 ]。结论 :介入组由于血管开通完全 ,肌红蛋白成倍高于溶栓组 ,且在ST段平方面积测定中表现梗死面积的减小     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.