胆汁反流性胃炎患者胆囊排空功能研究

目的研究胆汁反流性胃炎（ＢＲＧ）患者胆囊（ＧＢ）排空功能及其与胆汁反流的关系．方法采用随机、双盲和对照的方法，应用实时超声检查研究了３２例ＢＲＧ患者和２６例健康对照者的空腹ＧＢ容量（ＦＧＶ）和餐后ＧＢ排空功能．结果ＦＧＶ（ｃｍ３，ｘ±ｓｘ）ＢＲＧ患者（２３５±１５）明显大于对照组（１９７±１３，Ｐ＜００１）．餐后１５ｍｉｎＧＢ排出量（ＧＥＦ）ＢＲＧ患者即显著减少（Ｐ＜００１），餐后４５ｍｉｎ减少达最大（４５３％ｖｓ７０３％）．最大ＧＥＦＢＲＧ患者（６５４％）明显少于对照组（８０２％，Ｐ＜００１）．ＧＢ排空速度ＢＲＧ患者显著慢于对照组（Ｐ＜００１）．结论ＢＲＧ患者ＧＢ排空明显不良，可能系ＧＢ收缩无力和（或）Ｏｄｄｉ括约肌松弛不良所致；餐后ＧＥＦ减少与ＦＧＶ增多有关，从而使消化间期排入肠道的胆汁增多，当同时存在胃肠运动功能紊乱时即可反流入胃     

急性病毒性肝炎患者胆囊排空功能研究

目的研究急性病毒性肝炎（ＡＶＨ）患者胆囊（ＧＢ）排空功能及其与病情程度和转归的关系．方法用实时超声研究了３２例ＡＶＨ患者及２６例健康对照者ＧＢ排空功能．结果空腹ＧＢ容量（ＦＧＶ）ＡＶＨ患者（１０２２±２３１）明显小于对照组（１９７９±１５１）（Ｐ＜０００１），随病程延长，ＦＧＶ渐增多．ＦＧＶ减少与病情程度呈显著负相关（Ｐ＜００５）．餐后ＧＢ排出量（ＧＥＦ）ＡＶＨ组显著少于对照组（Ｐ＜０００１），其减少与病情程度呈明显负相关（Ｐ＜００１），与血清胆红质、ＡＬＴ水平呈显著负相关（Ｐ＜００５～００１）．６０ｍｉｎ最大ＧＥＦ及ＧＢ排空速度明显减少、减慢（Ｐ＜０００１）．恢复期ＦＧＶ及餐后ＧＥＦ均恢复正常．结论ＡＶＨ患者存在ＦＧＶ和餐后ＧＥＦ异常．其机制与肝细胞损害，泌胆功能障碍及神经—激素调控失调有关．     

非溃疡性消化不良患者体表胃电图与胃液体排空功能的研究

检测３１例非溃疡性消化不良（ＮＵＤ）患者及９例健康人（ＨＳ）空腹体表胃电图与胃液体排空功能，并观察了西沙必利对ＮＵＤ患者空腹体表胃电图与胃液体排空功能的影响。结果表明ＮＵＤ患者半排空时间（Ｔ１２）显著高于ＨＳ组（Ｐ＜００１）；胃液体排空延迟的ＮＵＤ患者（ＮＵＤ２组）ＦＰ值较胃液体排空正常的ＮＵＤ患者（ＮＵＤ１组）及ＨＳ组明显减低；ＮＵＤ２组正常慢波百分比也较ＮＵＤ１组及ＨＳ组显著减少；而且所有检查者的Ｔ１２值与体表胃电图的ＦＰ值及正常慢波百分比值呈良好的相关性（Ｐ＜００１）。ＮＵＤ２组服用西沙必利后ＦＰ值和正常慢波百分比值均恢复正常，消化不良症状积分及胃液体排空功能显著改善。体表胃电图的ＡＰ值３组之间无差异（Ｐ＞００５），ＮＵＤ２组服用西沙必利后ＡＰ值未发现明显变化（Ｐ＞００５）。     

功能性消化不良的体表胃电图研究

研究功能性消化不良（ＦｕｎｃｔｉｏｎａｌＤｙｓｐｅｐｓｉａ,ＦＤ）体表胃电图,探讨ＦＤ发病的病理生理机制。方法２３名ＤＦ患者及２０名健康志愿者,应用ＤｉｇｔｌａｐｐｅｒＥＧＧ记录仪进行ＥＧＧ检查,检查时间为餐前半小时、餐后回小时,试餐４％Ｋｃａｌ（５０ｇ火腿肠、营多牌方便面１包、４００ｍｌ开水）。结果健康组餐前主频（ｐＦ）、主功率（ＤＰ）、正常节律百分发比（Ｎ％）为：２．９±０．１ｃｐｍ、５７．６±１５．２ｂｐ、９０．９±１．９％;餐后：３．０１０．ＩＣｐｍ、２１２．７８±７２．５ｂｐ（Ｐ＜０．０１）、９２．６±２．１％。ＦＤ组餐前ＤＦ、ＤＰ、Ｎ％为：２．８±０．１ｃｍｐ、４８９．１±１５７．９ｂｐ、８１．８６±５．５％;餐后分别为：３．１±０．２ｃｐｍ、４７５．５±１２２．３ｂｐ、６７．５±４．４％（Ｐ＜０．０５）。结论ｍ患者存在胃电节律紊乱,此种节律紊乱主要表现在餐后功率降低及正常节律百分比下降,提示ＦＤ患者可能存在胃肌电活动异常。ＥＧＧ作为一种无创性胃动力检查方法,可用于ＦＤ患者的临床及研究工作。     

内镜下Oddi括约肌测压的临床意义

为观察胆石症、胆囊切除术后等胆系疾病及功能性消化不良（ＦＤ）、糖尿病胃轻瘫（ＤＧＰ）等非胆系疾病Ｏｄｄｉ括约肌（ＳＯ）功能变化，通过内镜采用灌注式高分辨多道胃肠功能测定仪，对１５例胆系疾病患者、１３例非胆系疾病患者进行Ｏｄｄｉ括约肌测压。结果显示，胆系疾病组的胆总管压力、ＳＯ基础压及蠕动波振幅明显高于非胆系疾病组（６．８６±０．６３ｋＰａ与１．２７±０．１０ｋＰａ，Ｐ＜０．０１；７．３１±０．９５ｋＰａ与１．８７±０．１６ｋＰａ，Ｐ＜０．０１；３２．００±１．２ｋＰａ与２４．１４±１．５ｋＰａ，Ｐ＜０．０５）；同时，非胆系疾病组的十二指肠压、ＳＯ蠕动频率及间期较胆系疾病组明显降低、减慢及延长（１．４２±０．２６ｋＰａ与０．３０±０．１０ｋＰａ，Ｐ＜０．０１；３．６±１．２次／分与２．２±０．４次／分，Ｐ＜０．０５；７．４±１．２秒与１１．０±１．８秒，Ｐ＜０．０５）。结果显示，无论是胆系疾病还是ＦＤ及ＤＧＰ等非胆系疾病均有ＳＯ功能紊乱，但表现形式相反，对指导临床诊断与治疗有一定价值。     

胆汁反流性胃炎患者Oddi括约肌松弛不良:硝苯吡啶改善胆囊排空作用研究

目的　研究胆汁反流性胃炎（ＢＲＧ） 患者胆囊（ＧＢ） 排空异常的发生机制．方法　按随机、双盲及对照的原则,用实时超声研究了３８ 例ＢＲＧ 患者和３０ 例正常对照组ＧＢ 排空功能及硝苯吡啶（Ｎｉ） 对ＧＢ 排空的影响．结果　空腹ＧＢ 容量ＢＲＧ 组明显多于对照组（ Ｐ＜ ０－０１） ,服Ｎｉ前后ＧＢ 容量无明显变化（ Ｐ＞ ０－０５） ． 餐后１５ｍｉｎ 起ＧＢ 排出量（ＧＥＦ） 即明显少于对照组（ Ｐ＜ ０－０１） ,４５ｍｉｎ 时更著． 口服Ｎｉ 后２５ｍｉｎ ＢＲＧ 组ＧＥＦ 即显著增加（ Ｐ＜ ０－０１） ,２０ ｍｇ Ｎｉ 更著;ＧＢ排空速度明显增快（ Ｐ＜ ０－０１） ;最大ＧＢ 排空时间明显缩短（ Ｐ＜ ０－０１） ． 服Ｎｉ 前后血浆促胃液素水平无明显差异（ Ｐ＞ ０－０５） ． 对照组口服Ｎｉ 后ＧＥＦ 明显减少（ Ｐ＜ ０－０１） ,２０ ｍｇ者更著．结论　Ｏｄｄｉ 括约肌松弛不良可能为ＢＲＧ 患者ＧＢ 排空异常的发生机制之一;口服Ｎｉ 有明显改善其ＧＢ 排空的作用,但对消化间期ＧＢ 排空无明显影响,Ｎｉ 改善ＧＢ 排空不依赖促胃液素．     

食管测压对反流性食管炎的诊断价值

目的探讨食管测压对反流性食管炎的诊断价值．方法使用专用软件控制的高分辨多道灌注测压系统（ＰＣｐｏｌｙｇｒａｆＨＲ瑞典产）测定了正常人１２例及反流性食管炎患者３２例的食管下括约肌动力指标、胸腹段长度及食管体动力参数．结果患者组ＬＥＳＰ，ＬＥＳＲＰ压力（ｋＰａ）明显低于对照组（１０±０７对２６±１０；０１±０４对０４±０２，Ｐ均＜００１）；食管中远段振幅（ｋＰａ）亦低于对照组（干咽：４６±３３对６５±２６，５３±３７对９１±３７，Ｐ均＜００５；湿咽：５３±３３对８９±３６，６１±４６对±１２４±４５，Ｐ均＜００５）．患者组ＬＥＳＬ１（ｃｍ）比对照组短（１７±０８对２６±０９，Ｐ＜００１）．结论反流性食管炎患者ＬＥＳＰ低下，ＬＳＥＬ１过短，食管体中远段动力低下，为临床选用动力药提供了客观依据     

尿毒症患者的体表胃电图研究

目的应用体表胃电图研究尿毒症患者是否存在胃肌电活动损害．方法应用双电极ＤｉｇｇｔｒａｐｐｅｒＥＧＧ对２５例有胃肠道症状的尿毒症患者和２５例健康志愿者进行餐前、餐后各３０ｍｉｎ胃电图检查，试餐２００８３２ＫＪ（１００ｇ营养麦片，２００ｍＬ开水）．结果健康组餐前主频（ＤＦ）、主功率（ＤＰ）及正常节律百分比（Ｎ％）分别为２９ｍｉｎ－１±０１ｍｉｎ－１，５７６ｂｐ±１５２ｂｐ，９０９％±１９％；餐后：３０ｍｉｎ－１±０１ｍｉｎ－１，２１２７８ｂｐ±７２５ｂｐ（Ｐ＜００１），９２６％±２１％．尿毒症组餐前ＤＦ、ＤＰ、Ｎ％分别为１１ｍｉｎ－１±０２ｍｉｎ－１，６５０４ｂｐ±４８０ｂｐ，４７０％±３９％；餐后１２ｍｉｎ－１±０２ｍｉｎ－１，３６４８ｂｐ±２４５ｂｐ，３３８％±３１％．以上结果与健康组相比均有显著性差异．结论尿毒症患者存在胃电节律紊乱，此种节律紊乱主要表现在正常节律百分比明显下降及餐后功率降低，提示尿毒症患者存在胃肌电活动异常．ＥＧＧ作为一种无创性胃动力检查方法，可用于严重肾功能衰竭、尿毒症患者的临床及研究工作     

溴化异丙托品与氨茶碱片对支气管扩张作用的对比观察

目的比较定量雾化吸入溴化异丙托品与口服氨茶碱片对支气管扩张的作用。方法对２６例稳定期慢性阻塞性肺疾病（ＣＯＰＤ）患者采用安慰剂控制的双盲交叉试验，于试验前及试验后３０分，１，２，３，４，５，６小时分别测定第一秒用力呼气容积（ＦＥＶ１）。结果使用溴化异丙托品及氨茶碱后ＦＥＶ１平均峰值较基础值增加分别为３４％及１９％（Ｐ＜０．０１）；达峰时间分别为１～２小时及２～３小时；ＦＥＶ１较基础值增加＞１５％的患者分别为９０％及５０％（Ｐ＜０．０１）；ＦＥＶ１＞１５％的平均持续时间为３．６小时及１．６小时，６小时内ＦＥＶ１较基础值平均增加分别为１８％及８％（Ｐ＜０．０１）。结论对ＣＯＰＤ患者雾化吸入溴化异丙托品较口服氨茶碱片能更有效的扩张支气管作用     

老年人非溃疡性消化不良的超声胃动力学研究──47例检测结果对照分析

采用单切面实时超声显像法对３１例老年非溃疡性消化不良患者及１６例健康对照者进行流体胃动力学多项指标检测。结果显示：患者组胃液体排空Ｔ＿１／２为３８．８±１０．５分钟，对照组２９．４±７．７分钟，差异有显著性（Ｐ＜０．０５）。同时患者组的胃窦收缩频率为３．３±１．０次／２分钟、胃窦收缩幅度为０．４±０．１、胃窦运动指数为１．５±０．９，对照组分别为４．４±１．７次／２分钟、０．６±０．２及２．７±１．９，差异均有显著性（Ｐ＜０．０５），且患者组胃液体排空时间延长与其胃窦运动指数下降相关（Ｐ＜０．０１）。老年患者组男性胃液体排空Ｔ＿１／２为３５．２±７．７分钟，女性为４４．４±１２．１分钟，差异有极显著性（Ｐ＜０．０１），表明老年男性患者胃液体排空Ｔ＿１／２正常，而女性患者延迟。提示胃动力学功能障碍在老年人非溃疡性消化不良发病中起一定作用。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.