Contribution of refractive errors to visual impairment in patients at korle-bu teaching hospital

Summary OBJECTIVE: To determine the contribution of refractive error to visual impairment in visually impaired patients attending Korle-Bu Teaching Hospital, Ghana. METHOD: This study was conducted over a period of 1 year beginning October 2002 at Korle-Bu Teaching Hospital. Every 4th consecutive new case attending the eye clinic, aged 6 years and above was selected and interviewed using a structured questionnaire. A Snellen's chart was used to determine the unaided visual acuity, visual acuity with spectacles where the patient was wearing one, and visual acuity with pin hole with or without spectacles. Improvement in visual acuity by 2 or more lines on the Snellen's chart when looking through the pin hole was regarded as an indication of refractive error. RESULTS: A total of 1,069 respondents, 594 female and 475 male were recruited into the study. One hundred and fifteen (115) patients (10.76%) were found to have impaired vision (Visual acuity worse than 6/18 to PL in the better eye). The vision of 51 of those with impaired vision improved when looking through the pin hole. Refractive error with Visual Acuity worse than 6/18 was present in 4.8% of all patients who attended the eye clinic. Refractive error was present in 44.3% of patients with visual impairment. CONCLUSION: Visual impairment was a common presentation and uncorrected refractive error was a major cause of visual impairment.     

Inflammatory bowel disease at the korle bu teaching hospital, accra

SummaryCase files of patients with Inflammatory Bowel Disease (IBD) managed by the author in the Medical Department over the period 1997 - 2004 have been reviewed to identify some features of the disease that may aid improved diagnosis and management. The findings indicate that IBD may not be rare in the country and that there is usually a long delay in establishing the diagnosis. It appears that, in Ghana, more males than females are affected and that most are fifty years of age or below. Malignant colonic change is uncommon but there is a high default rate among the patients. Five patients (29%) died. Cases managed in an Arab country, between 1987 and 1996, have been compared. In that group more female than male patients were affected but the commonest age group affected was similar. The diagnosis was similarly delayed but no deaths were recorded as opposed to the Ghana patients. Since Inflammatory Bowel Disease (IBD) is a potentially treatable condition medical practitioners need increased awareness to avoid undue delay in diagnosis.     

2种支架治疗梗阻性结直肠癌疗效对比分析

目的 :比较2种自膨式金属支架在梗阻性结直肠癌过渡治疗的安全性和效果。方法:收集2015年4月至2019年11月于重庆医科大学附属第一医院就诊的梗阻性结直肠癌并于结肠镜下置入支架的患者70例(2组分别为40例和30例)。分析一期手术率、支架置入成功率、临床缓解率和并发症发生率。结果:一期手术率为61.43%(70%vs. 50%,P=0.089)、置入成功率和临床缓解率分别为95.7%(95%vs. 96.7%,P=1.000)和94.3%(92.5%vs. 96.7%,P=0.824),并发症发生率为7.14%(10%vs.3.33%,P=0.547)。结论 :支架置入作为梗阻性结直肠癌术前过渡治疗,是一种安全、有效的方式,2种支架在有效性和安全性方面差异无统计学意义。     

Not only hysterectomy but also cesarean section can predict incomplete flexible sigmoidoscopy among patients with prior abdominal or pelvic surgery

BackgroundFlexible sigmoidoscopy (FS) is a safe and effective method for colorectal cancer (CRC) screening. Several studies have demonstrated that individuals who have undergone surgery are at a greater risk of having incomplete FS. This study explored predictors of incomplete FS and reduced polyp detection rates for participants who had undergone abdominal or pelvic surgery.MethodsFrom January 2009 to December 2009, individuals participating in health examinations and who had undergone abdominal or pelvic surgery were invited to participate in this investigation. Four experienced gastroenterologists performed examinations using a 60-cm Olympus video sigmoidoscope. Factors associated with incomplete FS insertions and reduced polyp detection rates were analyzed using logistic regression models.ResultsOverall, 106 eligible individuals were analyzed, and 45 (42%) incomplete FS insertions were reviewed. Fifty participants (47%) had undergone pelvic surgery, and the other 56 (53%) had undergone abdominal surgery. Pelvic surgeries were cesarean section (25%) and hysterectomy (15%); appendectomy (36%) was the most common abdominal surgery. The main pathological FS findings were hemorrhoids (54%) and adenomatous polyps (18%). Multivariate analysis indicated that only prior pelvic surgery [odds ratio (OR), 3.54; p = 0.01] was an independent risk factor for incomplete FS insertion. Incomplete examinations were inversely related to adenomatous polyp detection rates (OR, 0.23; p = 0.03).ConclusionPrior pelvic surgery, particularly cesarean section and hysterectomy, is an independent factor for incomplete FS insertion in a selected adult population. In addition, incomplete FS can increase the risk of missing polyps, particularly in individuals who underwent pelvic surgery.     

自身免疫性胃炎并发结肠息肉患者CagA、胃黏膜功能和自身抗体的变化

目的分析自身免疫性胃炎并发结肠息肉患者CagA、胃黏膜功能和自身抗体的变化。 方法纳入自身免疫性胃炎患者122例作为AIG组,另外收集同期萎缩性胃炎患者180例作为对照组。AIG组根据结肠是否有息肉,分为有、无增生性息肉组或有、无腺瘤性息肉组。比较各组血清胃泌素、细胞毒素相关基因A(CagA)、抗胃壁细胞抗体(PCA)、抗内因子抗体(IFA)、胃蛋白酶原Ⅰ/Ⅱ以及幽门螺杆菌感染情况。 结果122例AIG患者中,73例患者幽门螺杆菌感染阳性,46例CagA阳性,43例PCA阳性,46例IFA阳性。AIG组结肠多发性增生性息肉和腺瘤性息肉发生率高于对照组(P＜0.05)。有增生性息肉组幽门螺杆菌感染阳性率高于无增生性息肉组,有腺瘤性息肉组幽门螺杆菌感染阳性率和CagA阳性率高于无腺瘤性息肉组(P＜0.05)。 结论自身免疫性胃炎易伴有结肠增生性成腺瘤性息肉,可能与幽门螺杆菌感染有关。     

结直肠癌患者临床资料的对比分析

目的 掌握结直肠癌的发病情况及相关影响因素,寻找结直肠癌的发病规律,为今后结直肠癌的预防、筛查、诊治和预后等提供参考依据。方法 选取2008 年1 月-2014 年12 月在齐齐哈尔市第一医院行手术治疗的结直肠癌患者620 例为调查对象。收集患者的临床资料进行回顾性分析（包括患者人口学特征、临床症状、病理组织学分型、肿瘤部位及分化程度等）,利用EpiData3.0 软件建立数据库,运用SPSS20.0 软件进行统计分析。结果 结直肠癌患者中,男性368 例（59.4%）,女性252 例（40.6%）;结直肠癌中直肠癌287例（46.3%）,结肠癌333 例（53.7%）。首发症状以腹痛、黑便和腹胀为主;便常规潜血指标阳性者300 例（48.4%）,阴性者320 例（51.6%）。肿瘤标志物指标CEA 阳性者375 例（57.6%）,阴性者263 例（42.4%）。CA199 阳性者197 例（31.8%）,阴性者423 例（68.2%）;结直肠癌患者中,腺癌563 例（90.8%）,黏液癌52 例（8.4%）,印戒细胞癌3 例（0.5%）,未分化癌2 例（0.3%）。Dukes 分期A 期230 例（37.1%）,B 期130 例（21.0%）,C期186 例（30.0%）,D 期74 例（11.9%）。结论 通过对结直肠癌患者的人口学特征、临床表现及病理特点等方面进行探讨分析,为结直肠癌诊治及预后提供参考依据,应加强对高危人群进行筛查,做到早发现、早诊断、早治疗,提高患者的生存率和生活质量。     

大肠癌平均风险人群进展期肿瘤的年龄分布分析

目的 探讨汉族大肠癌无症状平均风险人群中不同年龄组进展期肿瘤的患病率,从而为确定最佳的大肠癌筛查开始年龄提供科学依据。方法 采用横断面研究设计,利用自制调查表对就诊于全国19家医院并接受结肠镜检查的大肠癌平均风险人群进行调查。调查内容包括人口学特征、生活方式、饮食习惯、肠镜检查结果等。基于之前已建立的平均风险人群大肠进展期肿瘤发生风险评分系统（由年龄、性别、吸烟、糖尿病、绿色蔬菜、腌制食品、油炸熏制食品、白肉等8个变量组成,总分为0-14分）,对研究对象进行发生风险评估,计算各风险等级进展期肿瘤患病率。不同风险等级、不同年龄组、不同性别之间进展期肿瘤患病率比较采用X2检验。结果 共7541例患者完成全结肠镜检查。随着危险评分增加,进展期肿瘤发生率也明显升高。风险评估得分为0-2分的研究人群中,70岁以下的年龄组进展期肿瘤发生率处于1.3-4.0%较低水平;70岁以上的年龄组进展期肿瘤的发生率处于8.9-15.3%较高水平;两组人群进展期肿瘤的发病风险差异有统计学意义（P <0.01）。风险评估得分为3-4分的研究人群中,45岁以下的年龄组进展期肿瘤的发生率处于3.6%较低水平;45岁以上的年龄组进展期肿瘤的发生率处于5.4-14.8%;两组人群进展期肿瘤的发病风险差异有统计学意义（P <0.01）。风险评估得分为＞4分的研究人群中,进展期肿瘤发生率处于9.8-22.7%较高水平,其40-44岁年龄组进展期肿瘤的发生率9.8%高于风险评估得分为0-2分的研究人群中70-74岁年龄组。在研究总体人群中,55岁以下的年龄组进展期肿瘤的发生率处于2.9-4.5%的较低水平;55岁以上的年龄组进展期肿瘤的发生率处于6.8-17.6%的较高水平;两组人群进展期肿瘤的发病风险差异有统计学意（P <0.01）。男、女性进展期肿瘤的高发年龄分别为45岁以后和60岁以后。 结论 不同风险人群、不同性别的最佳大肠癌筛查开始年龄不同。风险评估得分为0-2分的研究群体、风险评估得分为3-4分的研究群体、风险评估得分为＞4分的研究群体的最佳开始筛查年龄分别为70岁、45岁和40岁。女性开始筛查年龄可以比男性推迟15年。     

不同肠道清洁度下急诊肠镜对急性下消化道大出血的诊断价值

目的 探讨急性下消化道大出血患者进行急诊肠镜的必要性及最佳肠道准备方式.方法 收集近年南方医院188例急性下消化道大出血病例结肠镜检查相关资料,根据检查时机将患者分为急诊组与择期组,通过单因素分析不同肠镜检查时机对急性下消化道大出血诊断率的影响,在此基础上纳入肠道清洁度进行多因素分层分析,分析不同肠道清洁度对急诊肠镜诊断率的影响.结果 急诊组118例,择期组70例,两组的诊断率无统计学差异(P=0.724),但急诊组确定性出血灶的诊断率显著高于择期组(P=0.041),口服泻药的比例则显著低于择期组(P<0.001).肠道清洁度"优"、良"、差"在口服泻药及清洁灌肠的患者中的比例依次为63.6%vs 13.5%、28.6%vs 24.3%、7.8%vs 62.2%(P<0.001).单因素Logistic分析结果示,清洁度"优"较"差"显著提高肠镜诊断率(P=0.012),多因素logistic模型中,分组与清洁度的交互效应分析结果显示清洁度"优"时急诊组诊断率显著高于择期组(P=0.030);亚组分析结果显示,急诊组清洁度"优"时诊断率显著高于清洁度"差"(P=0.015).结论 当肠道清洁度为"优"时,急诊肠镜对急性下消化道大出血的诊断率优于择期肠镜,但通过清洁灌肠准备肠道时肠道清洁度差,从而降低了其诊断优势,因此在患者血流动力学稳定的前提下,急诊肠镜肠道准备应尽量选用口服泻药.     

加强结肠镜检查规范培训，提高结肠腺瘤检出率

我国结直肠癌发病率和死亡率逐年增加,针对其进行早防早筛早诊早治是遏制该趋势的有效措施,而结肠镜检查则是其筛查和检测的重要手段。腺瘤检出率是结肠镜检查的关键质控指标,提高腺瘤检出率不仅可以提高结肠镜的检查质量,更重要地是可以显著降低结直肠癌的发病率和致死率,具有重大临床意义。本团队从肠道准备质量、进镜操作技巧、退镜时间和质量、人工智能系统等不同层次寻找提高结肠镜学员腺瘤检出率的方法,力争在内镜医师的肠镜学习阶段为其打下坚实基础,从而切实改善我国结肠镜操作低腺瘤检出率的现状。     

180例大肠癌术中结肠镜检查的临床分析

目的探讨大肠癌术中结肠镜检查的临床意义。方法分析2000～2003年180例大肠癌术中结肠镜检查的临床资料。结果术中肠镜检查发现同时多源原发性大肠癌5例,大肠癌合并息肉20例。术前漏诊同时多源原发性大肠癌2例,大肠癌合并息肉8例。结论大肠癌术中肠镜检查有助于发现同时多源原发大肠癌和大肠癌合并息肉。     

腹腔镜联合结肠镜对结直肠息肉58例治疗效果分析

目的探讨腹腔镜、结肠镜联合治疗结直肠息肉的手术方法、安全性及临床效果。方法对我院2010年6月一2012年3月行腹腔镜、结肠镜联合手术切除的58例结直肠息肉患者的临床资料进行分析。结果手术均获得成功,无中转开腹。手术时间45～168（85．2±16．5）min,术中出血量15～65（33．4±8．1）ml。术后肠功能恢复时间为16～36（22．5±4．8）h,住院时间5～10（6．5±1．2）d。术后无吻合口漏、肠穿孔、肠梗阻等并发症。术后病理所见息肉直径大、绒毛管状腺瘤：多发的息肉发生癌变的概率较高。结论应用腹腔镜联合结肠镜治疗结直肠息肉的创伤小,并发症少,恢复快。对直径大、绒毛管状腺瘤、多发的息肉一经发现应尽快切除。     

直肠癌术后发生应激性溃疡出血的影响因素探讨

目的：对直肠癌患者术后发生应激性溃疡出血的相关因素进行探讨,降低应激性溃疡出血的发生率。方法：对我院2008年3月至2012年12月收治的直肠癌手术病例380例患者的临床资料进行回顾性分析,对可能引起术后应激性溃疡出血的因素进行单因素和非条件多因素Logistic分析,探讨引起应激性溃疡业血的独立危险因素。结果：对多种可能引起术后应激性溃疡出血的因素进行单因素分析后发现,年龄超过60岁、超过10年饮酒史、焦虑抑郁状态、淋巴结转移、术后有其他并发症及长时间手术均成为影响应激性溃疡出血的危险因素（P〈0．01）,有统计学意义。进行多因素Logistic分析后发现,除了超过10年饮酒史外,其余5种因素均可作为直肠癌术后发生应激性溃疡出血的独立危险因素（P〈0．01）,具有统计学意义。结论：引起直肠癌术后应激性渍疡出血的危险因素较多．临床可依据上述独立危险因素制定可靠的预防措施。以降低术后应激性溃疡出血的发生率。     

直肠癌术后局部复发再手术41例临床分析

目的探讨直肠癌术后局部复发的原因及再手术的临床效果。方法回顾分析1997~2002年41例直肠癌术后局部复发再手术病人的临床资料。结果吻合口处复发17例,盆腔内复发15例,会阴部复发(含造瘘口)9例。本组病例均经再次手术治疗,根治性切除24例,姑息性切除13例,行高位结肠造瘘4例。根治性切除和非根治性切除病人的中位生存时间分别为36个月和11个月。结论首次手术应切除足够的肠管,彻底清除淋巴结及所在的肠系膜,术中严格无瘤操作,围手术期制定合理的综合治疗措施是预防复发的关键因素。术后定期随访复查,对于局部复发早发现早再次手术可以延长生存期,提高生活质量。     

不同年龄段老年直肠癌的临床特征及术后并发症的危险因素分析

目的 探讨不同年龄段老年直肠癌患者的临床特征以及术后并发症发生的危险因素。方法 回顾性分析江苏大学附属武进医院普外科2011年5月至2016年5月行直肠癌根治术的272例老年直肠癌患者临床资料。根据年龄,分为普通组（65~74岁）146例,高龄组（≥ 75岁）126例,比较两组的临床特征及术后并发症。应用单因素以及多因素分析法分析术后并发症发生的相关因素。结果 与普通组相比,高龄组的麻醉风险评分（ASA）和Charlson合并症指数（CCI）评分更高,输血以及既往腹部手术史更多。术前合并症中,高龄组的慢性阻塞性肺疾病（COPD）、贫血和消化性溃疡更多、营养情况更差。高龄组的术后伤口感染、肺部感染、尿潴留和营养相关并发症发生率较普通组高,差异均有统计学意义（P<0.05）。单因素分析显示年龄、BMI、ASA评分、CCI评分、贫血、小野寺预后营养指数、高血压和COPD可能与患者术后并发症有关。多因素logistic回归分析显示CCI评分（OR=8.140,P=0.000）和贫血（OR=2.424,P=0.013）是术后并发症发生的独立危险因素。小野寺预后营养指数（OR=0.225,P=0.000）是术后并发症发生的独立保护因素。结论 随着年龄上升,直肠癌患者术前合并症增加、营养状况变差,进而导致术后并发症增加。CCI评分和贫血是术后并发症发生的独立危险因素。     

Management of perforated peptic ulcer in patients at a teaching hospital

OBJECTIVE: To explore and analyze the current status in management of patients with perforated peptic ulcers (PPU). METHODS: A retrospective study carried out at the Surgical Department, Al-Gamhouria Teaching Hospital, Aden, Yemen. Patients admitted with perforated benign peptic ulcers from January 1997 to December 2006 were included in the study. RESULTS: A total of 156 patients, 138 (88.5%) male and 18 (11.5%) female, with an overall mean age of 39.08 years (range 14-75 years) and a higher frequency of PPU was noted in patients 21-40 years (58.3%). The perforated duodenal ulcer and perforated gastric ulcer ratio was 4.38:1. The mean time of presentation was 16.5 hours, and operative intervention after admission was 5.25 hours. Simple perforation closure was used in 91.7% of the patients. Postoperative complication rate was 41% (statistically significant in cases admitted later than 12 hours), wound sepsis making the majority at 55.2%, 6 deaths (3.9%), the correlation with presentation time was not significant. The overall mean post-operative hospitalization period was 12.76 days; 14.7% of the patients stayed more than 3 weeks. CONCLUSION: Younger patients (21-40 years) were frequently affected. Emphasis should be placed on shortening the time to surgery. Simple closure remains the selected treatment in the majority of patients. Overall post-operative mortality was low (3.9%). Improving the surgical skills, wound care, administrative regulations, hospital environment, and equipment are needed to reduce the high rate of complications.     

糖尿病患者结直肠癌代谢组学的研究

目的 研究糖尿病患者结直肠癌组织代谢组学的改变。方法 采用气液相质谱仪(GC-MS)检测15例糖尿病结直肠癌患者的肿瘤和癌旁相邻正常组织的代谢谱的变化。结果 总共检测出有334种生化分子,结直肠癌组织样品和其匹配的健康邻近组织相比代谢状况发生了显著的变化。肿瘤组织中,葡萄糖、3-磷酸甘油酸和磷酸烯醇式丙酮酸含量显著下降(P<0.01),乳酸含量增加,糖代谢中瓦氏效应明显。用于肿瘤合成的嘌呤、嘧啶及其中间产物水平显著上调。甘油脂代谢中,甘油和甘油-3-磷酸的含量降低。结直肠癌组织中,β-丙氨酸、GPG、泛酸增加。结论 在糖尿病患者结直肠癌组织中,包括糖代谢等多种代谢通路发生了代谢重排。不常见的代谢物变化将来也许可以应用于结直肠癌的早期发现和治疗。     

The value of cytologic brushing with the aid of fiberoptic colonoscopy in the diagnosis of carcinoma of colon

Preoperative cytologic brushing and biopsy under direct Vision withfiberoptic colonoscopy(FC)and postoperative histopathologic examination wereperformed in 147 patients who were suspected of suffering from carcinoma of co-lon.In FC cytologic brushing,128 cases were positive for malignancy(87.1percent),18 false-negative(12.2 percent)and only one false-positive(0.7 percent).In the 146 FC biopsy specimens,124 were positive for malignancy(84 4 percent)and 22 false-negative and no false-positive.Combination of FC cytologic brushingwith FC biopsy could raise the diagnostic rate of colonic carcinoma to 95.2% anddecrease false-negative and false-positive because the two methods may replenisheach other in sampling and observation.Cytologic brushing is most valuable tothe early diagnosis of colonic carcinoma.When colonic stricture and obstructionprevent the colonoscope from reaching the lesion and FC biopsy cannot bedone,FC cytologic brushing is an effective method for diagnosis.The positiverate and false-negative rate of the cytologic brushing did not correlate to grosstyping,histopathologic typing and Dukes staging(P>0.05).The factorsinfluencing the correct diagnosis of colonic carcinoma by FC cytologic brushingare discussed in this paper.     

相位角在结直肠癌手术患者营养评估及预后预测中的应用

目的探讨生物电阻抗相位角（phase angle, PA）在结直肠癌（colorectal cancer, CRC）手术患者营养评估及预后预测的应用。方法选取同济大学附属第十人民医院胃肠外科241例CRC手术患者,入院时采用营养风险筛查2002（Nutrition Risk Screening 2002, NRS 2002）、患者主观整体评估量表(Patient Generated-Subjective Global Assessment, PG-SGA)、全球领导人发起的营养不良倡议（Global Leadership Initiative on Malnutrition, GLIM）行营养筛查与评估,完善人体成分测定,同时收集相关营养指标及预后指标,评价PA在营养评估及预后预测的应用。结果与正常PA组相比,低PA组体质量指数（body mass index, BMI）、骨骼肌质量指数（skeletal muscle mass index, SMI）、前白蛋白（serum prealbumin, PALB）、总蛋白（total protein, TP）、白蛋白（albumin, ALB）、血红蛋白（hemoglobin, HGB）、预后营养指数（prognostic nutritional index, PNI）呈下降趋势（P<0.05）,而年龄、纤维蛋白原（fibrinogen, FBG）、中性粒细胞/淋巴细胞比值（neutrophil/lymphocyte ratio, NLR）、血小板/淋巴细胞比值（platelet-to-lymphoccyte ratio, PLR）呈上升趋势（P<0.05）。营养风险及营养不良的患者PA明显下降（P<0.05）。PA与NRS 2002、GLIM存在一致性（P<0.05）。PA与年龄、FBG、NLR、PLR、NRS 2002、PG-SGA、改良格拉斯哥预后评分（modified Glasgow Prognostic Score, mGPS）、GLIM呈负相关,与BMI、SMI、PALB、TP、ALB、HGB、PNI呈正相关（P<0.05）。多元线性回归分析显示年龄、SMI、PALB、HGB、PNI、mGPS及GLIM对CRC手术患者的PA影响差异有统计学意义（P<0.05）。结论PA与CRC手术患者营养状况及预后指标密切相关,有利于辅助识别营养不良及预测预后,为及时进行营养干预及改善预后提供依据。