老年人十二指肠癌伴胃溃疡3例

目的本文报道较少见的老年人十二指肠癌伴胃溃疡的内镜和病理检查，并探讨内镜下特殊表现及病理学分类．方法在1994-01／1995-10常规内镜检查590例患者中，发现其中3例老年男性的特殊病变．内镜下观察例1为十二指肠球部变形，小结节性溃疡并胃窦部溃疡，例2为十二指肠球部菜花样隆起溃疡并胃角、胃窦部溃疡，例3为十二指肠球部不规则溃疡并胃角、胃窦部多个溃疡．结果对病变组织活检多块，进一步做病理学检查，并送外院复检．例2，例3为十二指肠腺癌并胃溃疡，例1为十二指肠鳞癌并胃溃疡。结论十二指肠癌中以腺癌为主，鳞癌的发现值得我们进一步探讨，对老年患者不能凭经验或满足于胃部首发病的诊断，并对溃疡或糜烂病灶尽量进行活检，以免漏诊．     

十二指肠肿瘤的影像诊断与内镜对比分析19例

目的为提高对十二指肠肿瘤的正确诊断率，本文进行影像诊断与内镜的对比分析．方法本组19例，分析了其X线表现，B超，CT表现与内镜所见及手术病理的情况．结果本组19例十二指肠肿瘤分良性4例，恶性15例，腺癌13例，息肉2例，炎性肿块1例，平滑肌肉瘤1例，脉瘤样增生1例，胃窦癌侵及十二指肠球部1例．肿瘤分类：且息肉型，2．溃疡型，3．浸润型．结论对十二指肠肿瘤采用多影像检查，综合分析诊断，能提高诊断率．     

十二指肠球部癌临床观察(附11例报告)

[目的]分析十二指肠球部癌的内镜及临床特点,以提高对十二指肠癌的认识和早期诊断率.[方法]回顾性分析河南宏力医院2007年1月1日至2012年12月31日经病理确诊为十二指肠球部癌11例患者的临床资料.[结果]首发症状表现为腹痛6例,反酸3例,黑便2例.肿瘤位于十二指肠球部前壁3例,小弯侧4例,后壁2例,弥漫型2例.病理类型腺癌9例,黏液细胞癌1例,鳞状细胞癌1例.11例患者全部经组织学检查确诊.血液肿瘤标志物癌胚抗原(CEA)检查10例,其中升高8(占72.72％),正常2例.6例患者具有典型的上消化道并发症,分别是食管癌术后复发、食管静脉曲张(重度)、食管高级别上皮内瘤变、胃角癌、贲门癌术后复发、反流性食管炎(LA-D级).治疗方式:外科手术治疗7例,内科化疗2例,保守治疗2例.[结论]十二指肠球部癌的首发症状多为腹痛,病变主要位于前壁及小弯侧,病理类型以腺癌为主,血肿瘤标志物CEA多升高,部分病例并发严重上消化道疾病,治疗方式主要为外科手术.总之,提高对十二指肠球部癌的全面认识,重视上消化道内镜检查及组织学检查,以便提高其诊断率.     

十二指肠溃疡必须作内窥镜活检吗?

十二指肠溃疡常靠内窥镜或钡餐检查诊断。但是,并非所有的十二指肠溃疡都是消化性的,故有时需作活检确诊。本文报道2例,最初由于相信内窥镜表现以及认为十二指肠溃疡总是良性的观点而误诊。例1:男,61岁,上腹痛伴呕吐2周。腹部检查无异常,血象和生化试验均正常,钡餐检查并经内窥镜证实在十二指肠球部有一直径0.5cm 大小的溃疡。患者以甲氰咪胍治疗2周无效而行剖腹探查术,术中发现为胰头癌侵蚀十二指肠球部,并影响邻近淋巴结。活检证实为胰头腺癌。15个月后,患者死于腹部癌症转移与黄疸。     

青年人进展期胃癌临床及内镜检查特点

目的讨论青年人进展期胃癌临床及内镜检查特点，误诊分析．方法青年人34例进展期胃癌，其年龄35岁以下，男性10例，女性24例，通过不同的临床症状、内镜检查、病理证实，讨论其特点．结果临床特点：①女性发病率高34例占24例；②临床症状归纳四点：a初发症状胃痛，疼痛程度重，性质为烧灼样．b上消化道出血也较多见，本组占21例，少数无胃痛而首发上消化道出血．c部分患者食欲不振，消化不良，短期体重下降．d少数患者吞咽困难，进食后胸骨后疼痛．③病程短进展快，如有的学者形容为奔马型胃癌，手术后生存6mo～2a．内镜检查特点：＠好发胃窦部，本组占16例．b癌灶呈巨大型，6例溃疡癌直径超过5cm以上、c多发性癌灶，本组7例多发癌．d肉眼包曼氏分型溃疡浸润型多见，本组20例．决之为溃疡型．e活检病理以未分化、粘液腺、印戒细胞癌多见．青年人胃癌误诊率高，有的学者认为门诊误诊率为96．6％，由于年龄的限制，共性的临床症状，极易误诊为胃炎及溃疡病．内镜下溃疡型胃癌易误诊为良性溃疡、隆起型易误诊为息肉，弥漫浸润性易误诊浅表胃炎，为减少误诊，加强对本病认识，有以上临床症状及早做内镜检查，内镜检查时不能满足一处病灶、注意有否多发癌可能，掌握好活检关，准确无误．息肉样癌钳取顶端，溃     

37例直径大于1.0cm十二指肠隆起性病变的临床、内镜、超声及病理分析

目的探讨十二指肠隆起性病变的临床,内镜、超声及病理特点。方法对37例十二指肠隆起性病变患者均采用Fujion EG-450型胃镜,Olympus UM-2R超声微探头检查及治疗,超声频率为7.5MHz～12MHz,高频电发生器为ERBE-200型。结果常规内镜发现隆起性病变位于十二指肠球部23例,降部14例。常规内镜诊断为十二指肠腺瘤性息肉14例,增生性息肉4例,腺癌2例。17例超声内镜诊断间质瘤11例,黏膜下囊肿4例,脂肪瘤2例。其中有24例病变术后病理诊断为腺瘤性息肉14例,增生性息肉4例,脂肪瘤2例,良性间质瘤3例,平滑肌瘤1例。7例疑为恶性间质瘤(术后确诊为恶性间质瘤4例,良性间质瘤2例,1例不明)。治疗有24例病变行高频电凝切除术,术后处理按我科常规进行;7例超声检查疑为恶性间质瘤,其中6例由外科手术治疗,1例保守观察;4例囊肿采用经内镜下囊肿套扎术治疗;2例十二指肠腺癌采取保守支持对症治疗。对上述所有病例仍在动态观察中。结论对于范围大于1.0cm的十二指肠隆起性病变常规内镜及病理检查、内镜超声检查对隆起性病变的诊断均具有重要价值。     

原发性十二指肠球部息肉样腺癌1例

原发性十二指肠球部息肉样腺癌起病隐匿,早期无特异性症状和体征,易被误诊为其他疾病.部分临床医师认为,十二指肠球部病变多为良性,很少进行活检和病理检查,但这可能导致误诊.临床医师在诊治过程中要拓宽思路,不能忽视十二指肠球部病变的少见病因.     

十二指肠球部微小黏膜隆起的临床分析

目的探讨十二指肠球部直径≤0.5cm黏膜隆起性病变的内镜特征、病理及其与临床的关系。 方法回顾性分析解放军总医院海南分院消化科2012年8月至2018年3月期间25例十二指肠球部微小黏膜隆起性病变的内镜表现特点及病理。 结果25例患者内镜表现为单个或多个广基息肉状隆起,10例患者于十二指肠球部黏膜隆起行活检病理检查,其中,十二指肠球慢性炎3例,十二指肠球慢性炎伴腺体增生2例,十二指肠球胃黏膜异位5例。 结论十二指肠球部黏膜直径≤0.5 cm的广基息肉状隆起多为慢性炎症所致的良性增生性病变及胃黏膜异位。     

十二指肠球部及降部隆起性病变的内镜分析及临床意义

目的通过对十二指肠球部及降部的隆起性病变的内镜分析,提高人们对该病变的认识。方法经电子胃镜、十二指肠镜、超声内镜、ERCP等检查方法,共检出十二指肠球部及降部的隆起性病变1 187例,对其进行内镜分析。结果本组十二指肠球部及降部隆起性病变共1 187例,其中息肉981例,恶性肿瘤69例,间质瘤53例,异位胰腺31例,囊肿27例,脂肪瘤26例,所占比例分别为82.65%、5.81%、4.47%、2.61%、2.27%、2.19%。981例息肉中,经病理证实肿瘤性息肉137例,占13.97%(137/981)。60 748例上消化道内镜检查中恶性肿瘤69例,其发生率为0.11%(69/60 748)。结论十二指肠球部及降部隆起性病变中息肉最为常见,其中肿瘤性息肉所占比例远高于文献报道,恶性肿瘤的发生率也较以前增加,人们应提高对十二指肠球部及降部隆起性病变的警惕。     

小肠肿瘤19例误诊分析

目的分析小肠肿瘤容易误诊的原因，以提高对小肠肿瘤的诊断率．方法我院7a间经手术及病理证实的小肠肿瘤31例，其中术前误诊19例，误诊率达61．2％．术前诊断为十二指肠溃疡（DU）4例，幽门不全梗阻5例，消化道出血原因不明4例，低位胆道梗阻2例，肠梗阻2例，卵巢肿物2例．年龄以50岁～70岁发病率高（12／19）占63％．临床表现以腹痛，消瘦，腹胀，呕吐，黑便，贫血为主，病程1wk～20a．结果手术中所见肿瘤部位：十二指肠11例（球部2例，降部8例，水平部1例）；空肠2例，回肠6例．肿瘤的性质：良性3例（平滑肌瘤2例，乳头状腺癌1例）；恶性16例（腺癌10例，平滑肌肉瘤3例，恶性淋巴瘤1例，恶性血管外皮瘤1例，乳头状腺瘤恶变1例）．单发病灶15例，多发灶4例（肺鳞癌伴小肠乳头状腺癌恶变1例，结肠癌伴十二指肠降部腺癌，回肠腺癌各1例，降结肠腺瘤伴回肠癌1例）．结论小肠肿瘤虽发病率不高，仅容易误诊，尤其是早期诊断更为困难。为防止误诊，提高诊断率，应对可疑患者进行全面细致的检查．     

Research and Evaluation of the Influence of the Construction of the Gate and the Influence of the Piston Velocity on the Distribution of Gases into the Volume of the Casting

Distribution of gasses to the cast volume and volume of pores can be maintained within the acceptable limits by means of correct setting of technological parameters of casting and by selection of suitable structure and gating system arrangement. The main idea of this paper solves the issue of suitability of die casting adjustment—i.e., change of technological parameters or change of structural solution of the gating system—with regards to inner soundness of casts produced in die casting process. Parameters which were compared included height of a gate and velocity of a piston. The melt velocity in the gate was used as a correlating factor between the gate height and piston velocity. The evaluated parameter was gas entrapment in the cast at the end of the filling phase of die casting cycle and at the same time percentage of porosity in the samples taken from the main runner. On the basis of the performed experiments it was proved that the change of technological parameters, particularly of pressing velocity of the piston, directly influences distribution of gasses to the cast volume.     

Weighing the QT Intervals with the Slope or the Amplitude of the T Wave

Objective: The reproducibility of QT interval measurements is low, even for the mean QT interval based on the standard ECG. In this study we analyzed whether the reproducibility of the mean weighed QT interval was better than the simple mean QT interval. The weighing was based on the amplitude of the T wave or the slope of the steepest tangent on the terminal part of the T wave. Material and methods: 12‐lead ECGs of 130 postmyocardial infarction patients were obtained. The QT intervals were measured by the tangent‐method on two occasions by the same observer Mismatch QT intervals were defined as QT intervals that were measured at only one occasion. Sixteen ECGs were rejected. The data were split into 34 and 80 ECGs for optimization and validation of the weighing, respectively. The weighed QT dispersion was calculated as the weighed mean of the three longest minus the weighed mean of the three shortest QT intervals. Results: Weighing with the slope increased the reproducibility by 41% (P = 3 10^‐6), but weighing with the amplitude reduced it by 20% (P = 0.02). However, if measurements with errors above 75 ms were rejected, weighing with the slope or the amplitude increased the reproducibility with 26% and 20% (P = 0.02), respectively. Weighing did not change the reproducibility of the weighed QT dispersion. Conclusion: Weighing with the slope improved the reproducibility of the mean weighed QT interval. However, if measurements with errors above 75 ms were rejected, weighing with the amplitude also increased the reproducibility. Weighing did not change the reproducibility of the weighed QT dispersion. Weighing is particularly efficient at reducing the negative impact of mismatch QT intervals on the reproducibility. A.N.E. 2002;7(1):4–9     

县级以下综合医疗机构医务人员对现代结控知识的认识现状调查

目的本文旨在了解医务人员现代结控知识掌握的现状及培训效果?方法于培训前后进行问卷调查,内容包括:病例发现?结核病诊断及化疗?结果培训前疫情报告和转诊,回答正确者占75.2%?71.7%;对临床表现?查痰和诊断依据,回答正确者占83.5%?42.5%?40.8%;抗痨药物?用药方法?化疗原则?短化方案?短化疗程?治愈标准六项,回答正确者占58%?14.4%?20.8%?9.2%?17%?24.3%?培训后再次调查发现,90%以上医务人员对现代结控基本知识已掌握?结论各级医务人员现代结控知识是很贫乏的,因此,对其进行系统培训是极为必要的,此项工作省时?省力?投入少,可收到事半功倍的效果。     

大骨节病病区水,粮实验对动物的骨和软骨中化学元素组成的影响

用质子激发 X 线荧光分析方法(PIXE)测定了大骨节病病区和非病区的水、粮以及用该水粮喂养的大白鼠的肋软骨和硬骨中22种化学元素的含量。结果发现水粮中存在差异的元素反应在用该水粮喂养的大白鼠的骨、软骨中也存在差异,含量都低的元素有 P、Mn、Cu、As、Zn。都高的有铅。其中锌低在水、粮、硬骨和软骨中都完全一致呈非常显著性差异(p<0.01)。提示病区水、粮中化学元素对骨质的影响不是单一元素缺乏或过多所致,而是多种元素的复合因素。     

Assessment of the Soft-Tissue Seal at the Interface between the Base of the Fixed Denture Pontic and the Oral Mucosa

Fixed dentures (bridges) are often selected as a treatment option for a defective prosthesis. In this study, we assess the contact condition between the base of the pontic and oral mucosa, and examine the effect of prosthetic preparation and material biocompatibility. The molars were removed and replaced with experimental implants with a free-end type bridge superstructure after one week. In Experiment 1, we assessed different types of prosthetic pre-treatment: (1) the untreated control group (Con: mucosa recovering from the tooth extraction); (2) the laser irradiation group (Las: mucosa recovering after the damage caused by a CO₂ laser); and (3) the tooth extraction group (Ext: mucosa recovering immediately after the teeth extraction). In Experiment 2, five materials (titanium, zirconia, porcelain, gold-platinum alloy, and self-curing resin) were placed at the base of the bridge pontic. Four weeks after the placement of the bridge, the mucosa adjacent to the pontic base was histologically analyzed. In Experiment 1, the Con and Las groups exhibited no formation of an epithelial sealing structure on the pontic base. In the Ext group, adherent epithelium was observed. In Experiment 2, the sealing properties at the pontic interface were superior for titanium and the zirconia compared with those made of porcelain or gold-platinum alloy. In the resin group, a clear delay in epithelial healing was observed.     

高胆红素血症对肿瘤标志物测定的影响探讨

目的探讨高胆红素血症对Ca19-9、Ca24-2和CEA检测的影响.方法对320例胆管、胆囊良恶性疾病病人,15例胆囊炎病人的胆汁和血清以及10例肝硬化、10例黄疸肝炎病人进行Ca19-9、Ca24-2和CEA检测.结果在良性胆管、胆囊疾病中,Ca19-9的假阳性最高;在胆红素增高的良性疾病中,Ca19-9假阳性率达46.7%;15例胆汁和血清以及10例肝硬化和10例黄疸肝炎病人中,Ca19-9的假阳性率分别为93%、20%、80%和80%.结论高胆红素血症对Ca19-9检测影响最明显,胆囊、胆管良恶性疾病鉴别时,以Ca24-2和CEA检测为佳.     

Echocardiography in the Emergency Department: From the Perspective of the Emergency Physician and the Cardiologist

Echocardiography performed in the emergency department must adapt to this new setting for noninvasive diagnostic testing. Emergency physicians require echocardiography to provide rapid diagnosis in life-threatening emergencies. New initiatives are being proposed by emergency physicians in the delivery of this test. Cardiologists now use echocardiography in the emergency-department to make the diagnosis of heart disease earlier and with greater accuracy.