Chronic pancreatitis with biliary obstruction.

In a 4-year review of 509 patients with chronic pancreatitis, the incidence of clinically manifest fixed common bile duct (CBD) stenosis was 9% (45 patients). In 76% this was alcohol related, and pancreatic calcification was present in 51%. All patients presented with unrelenting jaundice and five (11%) had cholangitis. The mean serum bilirubin (165 +/- 108, normal 0-17 mumol/l), alkaline phosphatase (1790 +/- 1143, normal 73-207 U/l) and gamma glutamyl transferase (798 +/- 660, normal 7-64 U/l) were markedly raised. Diabetes occurred in 8 (18%). A biliary drainage operation was performed in 43 patients and 11 had concomitant pancreaticojejunostomy. Endoscopic retrograde cholangiopancreatography (ECRP) provided valuable information preoperatively in outlining both biliary and pancreatic disease in selecting patients for dual ductal drainage. Minor complications not related to biliary anastomosis occurred in 14%. Four patients died (9%), two from pseudocyst-related haemorrhage. Jaundice was successfully relieved in all and did not recur during follow-up. No secondary biliary cirrhosis was encountered, but varying degrees of portal fibrosis were present in 75% of liver biopsies. The commonest biliary pathogen was E. coli. It is recommended that a biliary bypass operation be performed when the diagnosis is radiologically confirmed and no improvement occurs within 1 month.     

Chronic unilateral ureteral obstruction represented as renin-dependent hypertension

A 50-year-old woman developed renin-dependent hypertension immediately after accidental unilateral ureteral ligation during hysterectomy, and the hypertension lasted for 5 months. Surgical release of the obstruction was carried out 157 days after the ligation. Then, her blood pressure was normalized. However, the obstructed kidney showed intensive tubulointerstitial fibrosis and functional recovery was not obtained. This case suggests that the renin-angiotensin system may be upregulated in human kidney during unilateral ureteral obstruction for a long duration.     

Chronic alcoholic pancreatitis. Treatment by ductal obstruction

The results of treatment of seven patients with chronic alcoholic pancreatitis by ductal obstruction are presented. In addition, one case is reported in which pancreatic ductal obstruction was carried out that provided an opportunity to study the histologic changes resulting from ductal obstruction after a period of thirty-two months. The procedure we now prefer is described. This operation is the equivalent of subtotal pancreatectomy, but will not cause diabetes or ulcers.We believe the principle of complete ductal obstruction in the treatment of chronic pancreatitis is physiologically sound and has advantages not associated with other surgical approaches. The results to date warrant a continued trial of the procedure.     

改良间歇负压封闭引流治疗压疮疗效观察

目的克服负压封闭引流(VSD)治疗压疮的不足,提供高质量的压疮治疗方法。方法将87例Ⅱ~Ⅳ期压疮患者按分层随机抽样法分为三组。对照组(22例)处理创面后,喷撒利福平粉剂;VSD组(35例)创面应用VSD持续负压吸引;改良VSD组(30例)在常规VSD治疗的基础上,将1个厌氧包压在VSD敷料上,同时每日夜间停止负压吸引12 h。结果三组压疮治疗效果及治愈时间比较,差异有统计学意义(均P<0.01);改良VSD组和VSD组比较,差异无统计学意义(均P>0.05);改良VSD组、VSD组治疗效果均显著高于对照组,治愈时间显著短于对照组(均P<0.05)。改良VSD组匹兹堡睡眠指数量表(PSQI)测评结果除睡眠时间外,其余6个成分及总分显著低于VSD组(均P<0.01)。结论改良间歇VSD治疗在保证与常规VSD治疗同等疗效的前提下,避免了持续吸引带来的噪声、影响睡眠质量、被动体位等不良影响。     

Chronic fibrosing mediastinitis and superior vena caval obstruction from blastomycosis.

Chronic fibrosing mediastinitis is most commonly a complication of granulomatous disease caused by histoplasmosis. We report a case of Blastomyces dermatitidis causing superior vena caval obstruction from fibrosing mediastinitis.     

Chronic incomplete obstruction of the ureter: a new experimental model

To produce a chronic moderate hydronephrosis in dog, a method of partial ureteral occlusion using a specially designed polypropylene obturator was developed. In 11 of 14 dogs undergoing this procedure, excretory urography constantly revealed a moderate degree of hydronephrosis persisting for 7 weeks. Combination of this method in one ureter with the vaginal-cuff cutaneous ureterostomy, previously reported, in the contralateral ureter is a useful model for split renal function study of unilateral chronic hydronephrosis or obstructive nephropathy analogous to that of clinical case.     

小肠黏膜下基质的特性及组织修复应用现状

小肠黏膜下基质以其抗感染、免疫原性低等特性已应用于基础及临床研究的多个领域，但其在部分组织修复中出现的收缩等问题较为普遍，且在一定程度上影响着被修复组织的功能恢复，因此，如何有效避免修复后收缩等不良效果仍是有待解决的问题。本文通过对小肠黏膜下基质特性及组织修复现状进行查阅和总结，尤其是对收缩等问题的提出，为进一步正确认识小肠黏膜下基质组织修复能力提供可靠依据。