单光子发射型计算机断层扫描在下消化道出血诊断中的应用

目的 探讨单光子发射型计算机断层扫描（SPECT）显像在下消化道出血中的诊断价值。方法 回顾性分析24例下消化道出血患者SPECT显像资料。行异位胃黏膜显像者16例，行^99mTc－植酸钠（PHA）显像者4例，行^99mTc－红细胞（RBC）显像者4例，所有患者均接受手术并进行病例检查。结果 异位胃黏膜显像的阳性率为100％（16／16），特异性为93．7％（15／16）；^99mTc-PHA显像和^99mTc-RBC显像的阳性率分别为75．0％（3／4）和75．0％（3／4），但诊断缺乏特异性。结论 SPECT在美克尔憩室的诊断中有很高的灵敏度和特异性；对不明原因下消化道出血进行^99mTc-PHA显像或^99mTc-RBC显像可为临床提供出血灶定位参考。     

腹腔镜在小儿消化道出血中的应用

目的 :探讨腹腔镜在小儿消化道出血中的应用。方法 :应用小儿腹腔镜对 2 0例消化道出血患儿进行诊治。结果 :16例为美克尔憩室 ,1例为血管瘤 ,2例为肠重复畸形 ,以上均手术治愈 ;1例为过敏性紫癜所致肠道出血 ,经内科治愈。结论 :腹腔镜具有创伤小、安全、恢复快、并发症少、美观等优点 ,在小儿消化道出血中有很好的应用前景。     

小肠镜及其在消化道出血的临床应用

不明原因消化道出血约占消化道出血的3%~5%,主要发生在小肠部位。传统的检查方法常常难以到达出血部位,而小肠镜,特别是双气囊小肠镜和单气囊小肠镜的问世,不断增加了不明原因消化道出血的确诊率,并且可直接在镜下进行治疗。     

血管造影在急性消化道出血诊治中的价值（附41例报告）

急性消化道出血的正确诊断和及时处理，是临床外科较为棘手的问题。近年由于纤维内窥镜、核素扫描、选择性血管造影术等技术的发展，加上传统钡餐、钡灌肠检查以及各种止血方法的应用，使外科医生可根据不同的医疗条件合理选择检查手段和治疗方法。我院自1988年1月-1992年4月，     

腹腔镜在儿童下消化道出血中的应用

目的:探讨腹腔镜诊断和治疗儿童下消化道出血的临床价值。方法:对13例术前不明原因下消化道出血患儿行腹腔镜探查,12例确诊后11例经脐部延伸小切口,提出肠管在腹外手术;1例免于手术;1例病因不明。结果:11例患儿均未中转手术,手术时间40~90min,平均75min。术后5~10d出院,无任何并发症发生。结论:腹腔镜术具有创伤小、安全可靠、诊断率高等优点,适用于不明原因的儿童下消化道出血病例。     

纤维结肠镜在急性下消化道出血中的应用

下消化道由于肠道长 ,病变隐匿 ,引起出血的病变多 ,尤其大肠及回肠末端是血管瘤、肿瘤、结核 (ＴＢ)、炎性肠病 (ＩＢＤ )、淋巴瘤等出血性疾病的好发部位。出血不但与病变侵蚀血管破裂有关 ,而且还与肠腔内压力 ,肠管蠕动 ,血压及凝血机制等诸多因素有关 ,故给诊断带来较大困难。近年来 ,随着纤维结肠镜 ,肠系膜血管造影 ,同位素扫描等技术的成功应用 ,下消化道出血的诊治获得了巨大进步。特别是自 1969年纤维结肠镜应用于临床以来 ,下消化道出血的确诊率有了显著提高 ,它不但可以明确大多数下消化道出血的原因 ,而且还可通过内镜用高频电…     

内镜止血治疗在消化道出血中的临床应用

随着内镜下止血技术的普及,内镜治疗目前已成为消化道出血的首选止血方法［1］。通过内镜下寻找出血点,并利用多种止血技术进行及时止血,多可避免外科手术。目前临床常用内镜止血技术包括注射硬化剂止血术、金属钛夹止血、术氩离子凝固术和冰去甲肾上腺素止血术等,各种止血治疗均有不同优势,内镜止血也常需要联合应用几种不同的止血技术。复旦大学附属中山医院内镜中心自2012年1-12月间对32例不同原因引起的消化道出血患者进行内镜下止血治疗,取得满意效果,现总结报道如下。     

数字减影血管造影在消化道出血中的应用

目的 探讨数字减影血管造影(digital subtraction angiography,DSA)在消化道出血(obscure gastrointestinal bleeding,OGIB)中的应用.方法 回顾性分析22例消化道出血的血管造影表现及结果.结果 造影显示有出血灶14例,阴性8例;行介入治疗12例,行手术治疗12例.结论 DSA对消化道出血的诊断具有较高价值.     

探究残留钆对比剂对腹部CT图像的影响

目的 探究残留钆对比剂对腹部CT图像的影响及作用时间,使对患者的影像学检查实现最优化.方法 回顾性分析我院135例行上腹部CT检查患者信息,在同一受检者中,有钆对比剂残留的腹部CT图像标记为Ⅰ组;无钆对比剂残留的腹部CT图像标记为Ⅱ组;分别于Ⅰ组及Ⅱ组腹部CT图像的肝区、脾区、胰区、肾区进行三次CT值测量,取其平均值;...     

Massive gastrointestinal bleeding in infants with ascariasis

Although infestation with Ascaris lumbricoides causes various intestinal complications, massive gastrointestinal bleeding is rare. The authors report on 2 infants who presented with massive hematemesis. In the first patient, a gastroduodenoscopy was performed. Roundworms were found adhering to an oozing duodenal ulcer. Duodenal perforation occurred after extraction of the parasites. The second case was hematemesis together with peritonitis. Exploration found volvulus and a gangrenous segment of the distal ileum. Both infants previously passed roundworms with their stool. The authors conclude that the intestinal ascariasis can be a cause of massive gastrointestinal bleeding, especially in temperate and tropical countries.     

Massive low gastrointestinal bleeding due to a Dieulafoy rectal lesion

Massive low gastrointestinal bleedings are often difficult diagnostically and in terms of management. Sometimes, it is not possible to identify the bleeding point after performing diverse diagnostic tests and the patient undergoes a blind subtotal colectomy. With rectal bleeding, this form of surgery is completely useless, as it will not solve the cause of the haemorrhage. The Dieulafoy lesion has been widely described in the stomach, but in the rectum is a very rare entity that can cause massive lower gastrointestinal bleeding. In the literature, there are only 25 described cases of rectal Dieulafoy lesion.     

制备靶向相变型载硫化铋纳米粒并用于体外CT/超声显像

目的制备叶酸靶向相变型载硫化铋(Bi_2S_3)纳米粒(FBS-PFH-NPs)并用于体外细胞靶向及CT/超声显像。方法采用旋转蒸发法和声振法制备FBS-PFH-NPs,检测其基本性质;以宫颈癌Hela细胞验证FBS-PFH-NPs体外寻靶能力;观察60、90、120、150、180 W功率HIFU辐照后FBS-PFH-NPs回声强度和温度变化,以及纳米粒中Bi_2S_3浓度为1.0、2.0、3.0、4.0、5.0 mg/ml时FBS-PFH-NPs体外CT及超声显像效果。结果光镜下FBS-PFH-NPs呈球形,平均粒径(458.50±69.22)nm;Bi_2S_3均匀分布于其外壳,浓度为1.0 mg/ml。FBS-PFH-NPs大量结合于Hela细胞周围。HIFU辐照后,FBS-PFH-NPs发生液气相变,且随功率增高,FBS-PFH-NPs回声强度及温度均逐渐增高(F=110.09、440.69,P均0.01)。随纳米粒中Bi_2S_3浓度增高,FBS-PFH-NPs的CT值及回声强度均逐渐增高(F=146.14、16.74,P均0.01)。结论 FBS-PFH-NPs兼具靶向Hela细胞及CT/超声双模态显像能力。     

Outcome predictors in acute surgical admissions for lower gastrointestinal bleeding

Aim The BLEED criterion is a triaging model for lower gastrointestinal bleeding (LGIB), which was developed and validated in the USA. We assessed the BLEED criteria in a UK population and aimed to elucidate factors that can be implemented for early risk stratification. Method Patients were identified from a prospectively maintained surgical admission database at a central London teaching hospital. Data were collected on 26 clinical factors available on initial presentation. The primary‐outcome end‐points included severe bleeding (persistent bleeding within the first 24 h, blood transfusion, a decrease in haematocrit of ≥ 20% or recurrent bleeding after ≥ 24 hours of stability) and adverse outcome (emergency surgery to control bleeding, intensive care unit [ITU] admission or death). Results One hundred and eighty‐four clinical episodes were identified, representing 3% of all surgical referrals. Twelve patients with upper gastrointestinal bleeding were excluded. Severe bleeding occurred in 110 (64%) patients. An adverse outcome was recorded in 20 (11.6%) patients, and 10 (5.4%) patients died during admission. The commonest aetiologies were diverticular disease, haemorrhoids and malignancy. Four prognosticators of adverse outcome were identified, these being: creatinine > 150μm (P = 0.002); age > 60 years (P = 0.001); abnormal haemodynamic parameters on presentation (P = 0.05); persistent bleeding within the first 24 h (P = 0.05); and area under the receiver–operating characteristics curve (AUC) = 0.79. The BLEED criteria were shown to be nonpredictive (AUC = 0.60). Conclusion The BLEED criterion was not shown to have any predictive value in this patient cohort. Our study has determined an independent set of prognostic factors that could be incorporated into initial triaging of patients presenting with LGIB. This may facilitate the early identification of patients requiring more aggressive resuscitation, admission to a monitored bed and consideration for early radiological or surgical intervention.     

Rebleeding and survival after acute lower gastrointestinal bleeding

BACKGROUND: Previous studies of acute lower gastrointestinal bleeding (LGIB) have focused on evaluation and therapy. Measurement of long-term outcome has been rare. The purpose of this study was to document rebleeding and survival rates in patients with acute LGIB. METHODS: A retrospective review of all patients undergoing technetium-labeled red blood cell scans for LGIB from January of 1997 to December of 2002 was performed. Rebleeding was defined as identification of enteric bleeding requiring a transfusion 2 or more weeks after the initial bleeding episode. RESULTS: A total of 119 patients met inclusion criteria. Rebleeding was documented in 14 of 102 patients surviving for more than 2 weeks. The actuarial rebleeding rate was 15% at 2 years. No factors were identified that portended a higher likelihood of rebleeding. The 30-day mortality was 18% and the median survival was 60 months for the entire cohort. Of the 36 patients in whom cause of death was documented, 4 died of surgical complications and a single patient died as a direct result of hemorrhage. CONCLUSIONS: Rebleeding after an initial episode of LGIB occurs in a small percentage of individuals. Although survival is poor for patients with LGIB, few patients die as a direct consequence of hemorrhage.     

Effect of mechanical convection on the partitioning of an anionic iodinated contrast agent in intact patellar cartilage

To determine if mechanical convection accelerates partitioning of an anionic contrast agent into cartilage while maintaining its ability to reflect the glycosaminoglycan (GAG) content in contrast‐enhanced computed tomography (CECT) of cartilage. Bovine patellae (N = 4) were immersed in iothalamate and serially imaged over 24 h of passive diffusion at 34°C. Following saline washing for 14 h, each patella was serially imaged over 2.5 h of mechanical convection by cyclic compressive loading (120N, 1 Hz) while immersed in iothalamate at 34°C. After similar saline washing, each patella was sectioned into 15 blocks (n = 60) and contrast concentration per time point as well as GAG content were determined for each cartilage block. Mechanical convection produced 70.6%, 34.4%, and 16.4% higher contrast concentration at 30, 60, and 90 min, respectively, compared to passive diffusion (p < 0.001) and boosted initial contrast flux 330%. The correlation between contrast concentration and GAG content was significant at all time points and correlation coefficients improved with time, reaching R² = 0.60 after 180 min of passive diffusion and 22.5 min of mechanical convection. Mechanical convection significantly accelerated partitioning of a contrast agent into healthy cartilage while maintaining strong correlations with GAG content, providing an evidence‐based rationale for adopting walking regimens in CECT imaging protocols. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1333–1340, 2014.