贲门失驰缓症X线诊断初步探讨

目的探讨食管贲门失驰缓症的X线诊断表现及诊断．。方法对16例贲门失驰缓症进行食管钡餐检查，男性10人，女性6人，其中儿童10岁以内的两人，10岁以上的6人，均诊断为本病，对X线表现及诊断进行分析。结果16例贲门失驰缓症经钡餐透视均诊断为此病，其X线表现典型，诊断；位确，经临床治疗和手术正确率百分之百。结论X线钡餐检查仍为贲门失驰缓症的首选方法，可为内科治疗和外科手术的治疗提供有力的依据．     

胃镜直视下气囊扩张治疗贲门失驰缓症

目的:探讨胃镜直视下气囊扩张治疗贲门失驰缓症的方法和疗效.方法:采用内镜直视下气囊扩张术.结果:10例贲门失驰缓症患者吞咽困难完全消失7例、改善3例,2例患者一个月后复发,再次接受气囊扩张,症状明显改善,无大出血和穿孔等严重并发症.结论:胃镜直视下气囊扩张治疗贲门扩张失驰缓症是安全有效的方法.     

129例食管裂孔疝临床分析

作者收治129例食管裂孔疝，临床表现为反流性食管炎、胆绞痛、贲门失驰缓症、胃穿孔、渗出性胸膜炎、气胸、肠梗阻、消化道出血等症状及体征。胃镜检查贲门部松驰宽大，His角消失，胃底黏膜充血水肿、糜烂。钡餐检查，隔上可见疝囊影。认为食管裂孔疝临床症状复杂多样，有上述临床症状，应与本病进行鉴别诊断。     

诊断贲门失驰症又有新手段

诊断贲门失驰症又有新手段李系仁，李莉中国医大二院尹兴家、刘守君等人应用超声显像技术诊断７６例贲门失驰症患者，诊断准确率１００％。以往诊断贲门失驰症的常规检查方法是做钡餐透视，医生和患者都要受到放射线辐射。应用超声显像技术检查病人时，只需饮适量的水便可...     

支架置入治疗贲门失驰缓症术后并发症观察及护理

目的：探讨支架置入治疗贲门失驰缓症术后并发症的护理措施.方法：收集2008年1月-2014年7月开展支架置入治疗贲门失驰缓症的患者32例,密切关察病情变化,及时发现并发症并采取积极有效的护理措施.结果：在术后并发症得到了有效控制,提高了患者的生活质量.结论：运用积极有效的护理措施可提高支架置入治疗贲门失驰缓症的疗效,提高患者的生活质量,促进患者早日康复.     

气囊扩张治疗食管贲门失弛缓症38例临床观察

目的总结内镜直视下气囊扩张器治疗食管贲门失弛缓症的疗效。方法38例贲门失弛缓症患者行内镜直视下气囊扩张治疗,比较分析扩张前后临床症状、术后1个月及1年的吞咽困难改善情况。结果38例患者中36例术后吞咽困难症状迅速消失,2例稍有改善,随访1个月及1年的有效率分别为94%、75%,1年失访共4例,复发6例。11例接受食管测压者扩张4周后LES-P较扩张前有明显下降(P<0.01)。未见有出现气胸,穿孔,消化道大出血等并发症。结论气囊扩张术治疗贲门失驰缓症简便、安全、有效,成功率高,并发症少,是治疗贲门失弛缓症的首选方法。     

贲门失驰缓症的外科治疗体会

自1994～2003年,我院共收治贲门失驰缓症30例,均采用Heller术 胃底折叠治疗.现报告如下. 1 临床资料 本组30例,其中男22例,女8例.年龄11～60岁;病程5个月～24 a.全组均有不同程度的间歇性吞咽困难;28例有呕吐,呕吐物为食物.10例伴胸骨后及上腹疼痛.X线食管检查,贲门处均显示萝卜根或鸟嘴状,12例有不同程度食管下段扩张,其中1例横径达6 cm.全组术前均做了纤维食管镜检查,3例食管贲门处正常,1例纤维食管镜不能插入,26例食管下段及贲门均有狭窄、管腔变小,进镜有阻力,但稍加用力镜身即可通过贲门.     

贲门失驰缓症的诊断及治疗体会

本文1990年至1996年共收治的7例贲门失驰缓症,现对其诊断及治疗的体会报告如下。1 临床资料本组男5例,女2例。年龄18岁～45岁,平均35岁。7例均有吞咽梗阻,其中5例呈间歇性,且呈进行性加重,晚期病例仅能进流质。6例进食后引起呕吐,仅2例吞咽时有胸骨后轻度疼痛感。入院前均做过胃镜检查,5例未发现肿块,另2例见贲门部     

贲门失驰缓症的诊治

贲门失弛缓症又称贲门痉挛、巨食管,是由于食管贲门部的神经肌肉功能障碍所致的食管功能性疾病。其主要特征是食管缺乏蠕动,食管下端括约肌(LES)高压和对吞咽动作的松弛反应减弱。临床表现为吞咽困难、胸骨后疼痛、食物反流以及因食物反流误吸入气管所致咳嗽、肺部感染等症状。贲门失弛缓症在我国缺乏流行病学资料,在欧美等西方国家该病的发生率每年约为1/10万,男女发病率相似,约为1:1.15。本病多见于20~50岁的青壮年,但其他年龄段也可发病,病程多较长。贲门失驰缓症的诊断     

扩张治疗贲门失驰缓症16例报告

贲门失驰缓症又称贲门痉挛，它是食管下２／３的运动发生障碍的一种疾病，咽下困难是本病突出的症状，以往单用药物治疗疗效多不满意，手术治疗创伤大、费用高、不宜首选，近年来我们采用Ｓａｖａｒｙ扩张器扩张治疗贲门失弛缓症，取得满意效果，现报告如下。１资料与方法...     

内镜直视下气囊扩张术治疗贲门失弛缓症的随访研究

目的观察评价贲门失弛缓症的内镜直视下气囊扩张术的疗效。方法选择92例贲门失弛缓症并经过内镜下气囊扩张术治疗的患者,术后6个月、1年、2年定期随访,详细询问病史,并经内镜和钡餐检查对原有的吞咽困难等症状缓解程度进行评估。结果92例患者吞咽困难症状均有显著改善。1次扩张有效率达86.9%,2次有效率可达100%。术中可见贲门黏膜撕裂、渗血,未见致命性出血及穿孔等并发症。结论内镜下气囊扩张术治疗贲门失弛缓症可获得良好的近期和远期疗效,具有安全、简便、价廉的特点,是治疗贲门失弛缓症的首选方法。     

Laparoscopic myotomy in 14 patients with achalasia after unsuccessful pneumatic dilatations: effective and safe]

OBJECTIVE: Evaluation of laparoscopic myotomy with or without an anti-reflux (Dor) procedure in patients with achalasia. DESIGN: Retrospective. METHOD: Data were collected from patients who underwent a laparoscopic myotomy for achalasia, following repeated pneumatic dilations. In the period 1993-1998, seven patients were treated in the Dijkzigt location of the Erasmus University Hospital (Rotterdam, the Netherlands). In the period 1995-1999 seven patients were treated in the Free University Hospital (Amsterdam, the Netherlands) by means of a laparoscopic myotomy followed by Dor fundoplication. All of the patients received a check-up from their specialist according to a protocol and in 2000 they were requested to complete a questionnaire concerning how satisfied they were with the operation. RESULTS: In both groups the age ranged from 20 to 60 years (mean ages were 39 and 36 respectively) and the number of men and women was almost equal. There was no conversion. Average operation time was 1.5 hours for the group without fundoplication and 2.5 hours for the group with fundoplication. No perioperative or postoperative complications occurred. During the follow-up period (mean: 3.5 years; range: 1-7) one recurrence was encountered. In the group without fundoplication, reflux oesophagitis was observed in five of the patients. No reflux was encountered in the group with the added fundoplication. All of the patients preferred laparoscopic myotomy to pneumatic dilations. CONCLUSION: Laparoscopic myotomy was an effective and safe treatment for achalasia following repeated pneumatic dilations. The patients themselves were also satisfied. Without fundoplication, reflux oesophagitis was more prevalent.     

腹腔镜手术治疗贲门失弛缓症的临床研究

目的 分析腹腔镜手术治疗贲门失弛缓症的并发症以及中短期疗效.方法 回顾性分析腹腔镜手术治疗贲门失弛缓症41例患者的临床资料,观察疗效.结果 41例患者无死亡病例.所有患者均行腹腔镜Heller食管贲门肌切开术与胃底折叠术,其中39例患者行Dor前部分胃底折叠术,2例患者存在裂孔疝行Toupet胃底折叠术.手术时间平均142 min.7例发生术中并发症,其中6例为轻度并发症.术后平均随访21个月.临床疗效优27例,良7例,一般5例,差2例.结论 腹腔镜Heller食管贲门肌切开术中短期的疗效较好,并发症发生率低,可作为贲门失弛缓症的首选治疗方法.     

Audit of surgical and pneumatic/hydrostatic treatment of achalasia in a defined population.

A retrospective survey was made of all the patients resident in the Nottingham area who presented with achalasia between 1959 and 1983. Initial treatment consisted of pneumatic bag dilatation in 26, hydrostatic bag dilatation in one and surgical cardiomyotomy in 22. Those treated by dilatation were older (mean age 52 years) than those treated by cardiomyotomy (mean age 42 years). Seven patients died without receiving active treatment because of old age and infirmity and in 6 this occurred before the introduction of endoscopic dilatation to the area. Initial treatment by cardiomyotomy was associated with a lower recurrence rate than treatment by bag dilatation but with a longer stay in hospital and a higher incidence of complications including empyema, chest infections and oesophageal stricture.     

气囊扩张治疗贲门失弛缓的临床研究

目的探讨气囊扩张治疗贲门失弛缓的疗效。方法选择2010年2月—2012年2月期间该院收治的贲门失弛缓患者43例,给予3.2cm的气囊扩张,共进行58次治疗,观察对比治疗前后的症状评分及钡餐检查后1min及5min的存钡宽度及高度,以此评价治疗效果。结果本组43例患者于治疗前后主要症状评分均有显著下降,与治疗前相比,P<0.05。且通过气囊扩张的有效治疗,对食管钡剂排空起到显著的改善作用。治疗总有效率为76.74%。结论采取气囊扩张治疗贲门失驰,效果显著,可有效改善患者症状,提升患者生活质量。     

血内皮祖细胞与一氧化氮在慢性阻塞性肺疾病并发肺动脉高压患者中的变化及意义

目的 观察慢性阻塞性肺疾病（COPD）并发肺动脉高压（PAH）病人外周血内皮祖细胞（EPCs）数量和功能及一氧化氮的变化,并探讨其在COPD并PAH发病中的作用.方法 选择本院住院的COPD病人60例,其中COPD并PAH（COPD＋PAH组）病人30例,COPD非PAH病人30例（COPD组）;正常对照20例（非COPD组）.用密度梯度离心法从外周血获取单个核细胞,将其接种在人纤维连接蛋白包被培养板,培养7d后对贴壁细胞进行细胞化学分析.通过集落形成试验、改良的Boyden小室和黏附能力测定实验计数EPC的数量、测定EPC的迁移和黏附能力.用硝酸还原酶法比色检测入选患者血浆一氧化氮（NO）水平.结果 和正常对照组[（24.9±4.1）克隆形成数]及COPD组[（21.9±3.9）克隆形成数]相比,COPD＋PAH组[（14.2±3.5）克隆形成数]外周血EPC数量明显减少,黏附和迁移能力显著降低（F≥9.15,q≥3.49,P〈0.05）,且EPC数量及黏附、迁移能力与肺动脉压力呈负相关（r=-0.79、-0.85、-0.89,P〈0.01）.COPD＋PAH组患者NO水平[（43.6±4.8）ng/ml]明显低于对照组[（67.17±4.9）ng/ml]（P〈0.01）,NO浓度与循环EPCs数量及迁移能力呈正相关（r=0.77、0.71,P〈0.01）,与循环EPCs黏附能力无关.结论 COPD病人PAH的发生可能与循环EPCs数量减少、迁移和黏附能力降低有关,这种变化可能与血浆NO水平减少有关.     

伴与不伴自杀行为的抑郁症患者临床症状与甲状腺激素的比较

目的 探讨伴与不伴自杀行为的抑郁症患者的临床症状与甲状腺激素水平的异同.方法 采用放射免疫分析法检测抑郁症自杀未遂患者56例、无自杀行为患者85例的血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）的水平,同时进行症状自评量表（SCL-90）的评定.结果 抑郁症自杀未遂组抑郁因子评分[（2.90±1.01）分]高于无自杀行为组[（2.51±0.77）分]（t=2.127,P=0.036）;抑郁症自杀未遂组血FT3[（3.92±0.52）pmoL/L]低于无自杀行为组[（4.18±0.71）pmoL/L]（t=-2.219,P=0.028）.结论 伴自杀行为的抑郁症患者临床症状有一定特征性,低血FT3水平对评估抑郁症自杀风险有重要意义.     

Achalasia following gastro-oesophageal reflux.

Five patients initially presenting with symptomatic gastro-oesophageal reflux, proven by radiology or pH monitoring, subsequently developed achalasia, confirmed by radiology and manometry, after an interval of 2-10 years. During this period dysphagia, present as a mild and intermittent symptom accompanying the initial reflux in 3 of the 5, became severe and resulted in oesophageal stasis of food in all. Three of the 5 had a demonstrable hiatal hernia. In none was reflux a troublesome symptom after Rider-Moeller dilatation or cardiomyotomy undertaken for the achalasia. Gastro-oesophageal reflux does not protect against the subsequent development of achalasia. It is suggested that the autonomic damage eventually leading to achalasia may in its initial phases cause gastro-oesophageal reflux.     

Incidence of polymyalgia rheumatica at a department of internal medicine

Polymyalgia rheumatica can be characterised by pain and stiffness in the shoulder and pelvic girdles, with a raised ESR and a dramatic response to corticosteroid therapy. Case reports and clinical symptoms of six patients with polymyalgia rheumatica are reported by the authors. All of the patients were female with mean age 54.3 years. 11.8 months were registered between the initial symptoms of the disease and the establishment of the diagnosis. This relatively long period of time can be caused by the poor recognition of the disease, besides the difficulties of the diagnosis.     

Barriers to diagnosis of occupational asthma in Ontario

BACKGROUND: Occupational asthma (OA) refers to asthma caused by workplace-specific substances. A longer duration of symptoms while continuing to be exposed has been associated with a worse prognosis. Evidence suggests a significant period of time exists between symptom onset and diagnosis of OA, the reasons for which have not been investigated. The purpose of this study was to examine whether primary health care and/or socio-economic factors account for delays in Ontario. METHOD: Two hundred and forty-seven (247) chart reviews were undertaken of patients referred to the University Health Network Asthma Centre for evaluation of OA, with clinic visits from 1997-2002. Forty-two (42) patients fulfilling objective OA criteria were administered a structured telephone interview to examine the chronology and nature of health care consultation and reasons for possible delay in diagnosis. RESULTS: The mean time to diagnosis was 4.9 years (3.4 years excluding 4 outliers). On average, patients waited 7.4 months before discussing the work-relation of symptoms with a physician. Main self-reported reasons for delay were lack of enquiry about work relatedness by the primary care physician (41%) and fear of losing work time (37%). Reported increases in time during secondary care were related to difficulties associated with completion of investigations (35%). Lower education level (p = 0.04) and household income (p = 0.03) were significantly associated with an increased time to diagnosis. INTERPRETATION: Physicians who assess working adults with asthma need to ask pertinent work-related questions when taking a history in order to initiate timely investigations and referral. Socio-economic factors are also associated barriers to early diagnosis of occupational asthma.