X-ray contrast examination in surgery of adhesive intestinal obstruction

The nature, frequency, and informative value of contrast X-ray examination of the gastrointestinal tract after oral administration of liquid barium in the adhesive disease and adhesive ileus were studied in two groups of patients (123 and 162 persons). Signs such as prolonged retention of the contrast medium in the small intestine and "sagging" of the intestine with the appearance of an X-ray contrast level in the absence of gases above it are of most diagnostic significance. Goal-oriented X-ray contrast examination made it possible to reduce the time needed for preoperative diagnosis, reduce the number of operative interventions in which the intestinal lumen is opened, and improve the immediate outcomes of treatment; mortality reduced from 19.8% to 10.5%.     

碘化油小肠造影对粘连性肠梗阻治疗的指导作用

目的观察碘化油小肠造影对粘连性肠梗阻治疗的指导作用。方法对200例患者行小肠造影,通过腹部X线摄片动态观察造影剂在胃肠道中的位置及通过情况,以确定梗阻部位以及梗阻是否完全,从而确定治疗方法。结果200例中102例造影剂在24h内到达结肠而给予保守治疗,101例症状消失。另98例见造影剂不能到达结肠而行手术治疗。结论碘化油小肠造影在对粘连性、非绞窄性肠梗阻明确梗阻部位及治疗方法的选择方面有很好的指导作用。     

The diagnostic value of water-miscible contrast ventriculography

Summary This report is based on the authors' personal experience of fifty three studies using Conray 60. The diagnostic role of water-miscible contrast media for ventriculography in neurosurgical patients is discussed.Conray studies of lesions involving the various parts of the ventricular system are illustrated. The possible complications are assessed in relation to the value of the investigation.     

Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value

Background

Adhesive small bowel obstructions are the most common postoperative causes of hospitalization. Several studies investigated the diagnostic and therapeutic role of water-soluble contrast agent (WSCA) in predicting the need for surgery, but there is no consensus.

Methods

A systematic review and meta-analysis was done of studies on diagnostic and therapeutic role of oral WSCA.

Results

WSCA had a sensitivity of 92% and a specificity of 93% in predicting resolution of obstruction without surgery; diagnostic accuracy increased significantly if abdominal X-rays were taken after 8 hours. The administration of oral WSCA reduced the need for surgery (odds ratio .55, P = .003), length of stay (weighted mean difference −2.18 days, P < .00001), and time to resolution (weighted mean difference −28.25 hours, P < .00001). No differences in terms of morbidity or mortality were recorded.

Conclusions

The administration of WSCA is accurate in predicting the need for surgery; the test should be taken after at least 8 hours from administration. WSCA is a proven safe and effective treatment, correlated with a significant reduction in the need for surgery and in the length of hospital stay.     

螺旋CT对不明原因肠梗阻的诊断价值

目的:探讨CT检查对不明原因肠梗阻的诊断价值。方法:回顾性分析115例不明原因肠梗阻患者的CT表现。结果:CT对115例不明原因肠梗阻患者的肠梗阻部位、原因、梗阻程度能准确诊断的110例，诊断率95.7%。结论:腹部CT检查为不明原因肠梗阻的梗阻部位、梗阻原因和梗阻程度确定提供快速、简便、有效的诊断手段，是临床医生拟定治疗方案的重要依据。     

超声造影对肾脏占位病变的诊断意义

目的评价超声造影对彩色多普勒超声诊断肾肿瘤的临床意义。方法应用彩超检查２７个（２６例）肾脏占位病变,观察超声造影前后病变内血流显示情况。结果超声造影后：（１）肾癌病灶内血流信号明显增强,显著增强者占７２％;（２）肾错构瘤７５％无增强,肾囊肿均无增强;（３）肾柱肥大增强与肾实质一致。造影前后诊断敏感性分别为７４％与１００％。结论超声造影有助彩超更准确评价肾肿瘤血供状况,对肾占位病变诊断与鉴别有重要临床意义。     

Urinary retention without subvesical obstruction. Differential diagnostic considerations

Acute urinary retention without subvesical obstruction is associated with neurogenic or nonneurogenic disorders of bladder function. Urodynamic investigations differentiates sensoric and/or motoric disturbances of the micturation. Neurologic and laboratory examinations are necessary to clear the etiology. Symptomatic urological treatment and specific etiological therapy should be used to manage this entity.     

组氨酸脱羧酶与绞窄性肠梗阻的诊断

早期诊断绞窄性肠梗阻是肠梗阻治疗中的难点之一.通过血清学指标早期诊断肠梗阻是近年来临床研究的热点.研究显示组氨酸脱羧酶在肠梗阻胃肠黏膜损伤的诊断中具有较高的灵敏性和特异性,有望成为绞窄性肠梗阻早期诊断的有效血清学指标.本文就血清组氨酸脱羧酶水平与绞窄性肠梗阻诊断的研究进展进行综述.     

The diagnostic value of double contrast CT in shoulder dislocation]

The article reports of the indication, technique and results of the shoulder joint double-contrast-computertomography. It discuss its diagnostic value in comparison to other examining methods. As alternative preoperative diagnostic procedures only arthroscopy, arthrography and MRI can be considered. Also discussed are the therapeutic consequences resulting from the nature of the pathological lesions (rupture of the limbus glenoidalis, Hill-Sachs-defect, reversed Hill-Sachs-defect). Especially for the first traumatic dislocations of the shoulder joint, we consider this investigational method an eminent enlargement of the diagnostic spectrum. Therefore, we are generous with its indication, attempting to prevent reluxations by primary diagnostic and therapeutic procedure.     

水溶性造影剂在粘连性小肠梗阻治疗中的价值

【摘要】 目的 探讨水溶性造影剂(泛影葡胺)在粘连性小肠梗阻治疗中的价值。方法〓明确诊断为小肠梗阻的患者,不合并肠穿孔、腹膜炎及绞窄性肠梗阻等需要急诊手术的情况。采用前瞻性研究方法,将入组的57例患者分为2组:对照组与治疗组。对照组给予常规治疗,如禁食、胃肠减压、灌肠、静脉补液等;治疗组除常规保守治疗方法外,患者口服或均经胃肠减压管注入76%泛影葡胺60~100 mL并夹管1小时,观察两组非手术治疗的有效率、小肠梗阻缓解时间、住院时间以及并发症的发生情况。结果〓应用泛影葡胺的治疗组非手术治疗的有效率明显高于对照组(83.3% VS 55.6%),差异有统计学意义;非手术治疗有效的两组患者中,治疗组患者在肠鸣音恢复时间9.56±3.47 h VS 19.67±3.90 h)、肛门排气时间(11.24±3.15 h VS 22.6±4.14 h)、每日胃肠减压量(179.20±68.79 mL VS 323.33±91.31 mL)、住院时间(5.0±1.83 d VS 8.20±2.15 d)均明显小于对照组,各指标间的比较均有显著性差异。两组均未出现严重并发症。结论〓泛影葡胺治疗小肠梗阻疗效确切,值得推广应用。     

内镜下经鼻型肠梗阻导管在粘连性肠梗阻中的应用

目的探讨内镜下经鼻型肠梗阻导管在治疗粘连性肠梗阻中的应用价值。 方法回顾性分析2012年9月至2013年9月吉林大学中日联谊医院收治的粘连性肠梗阻患者30例,其中15例在术前行肠梗阻导管肠减压治疗,术中行肠梗阻导管小肠内支架排列,作为观察组;另外15例术前行胃肠减压治疗,术中未进行肠排列,仅应用防粘连材料,作为对照组。分别对比两组患者的手术时间、术中出血量、术后排气时间、术后住院时间、术后再次出现肠梗阻的概率等,观察其临床疗效。 结果观察组的术后排气时间(1.52 ± 0.87)d,术后2年内复发概率6.7%;对照组的术后排气时间(2.63 ± 0.59)d,术后2年内复发概率40.0%。两组患者在手术时间、术中出血量、术后住院时间比较,差异无统计学意义(P > 0.05),但是在术后排气时间及术后2年内复发概率上,观察组明显优于对照组[(1.52 ± 0.87)d vs (2.63 ± 0.59) d (P＝0.013)、1例 vs 6例(P＝0.001)]。 结论肠梗阻导管肠排列能有效的促进术后肠道功能的恢复,并预防粘连性肠梗阻的复发。