Enkephalin inhibits relaxation of the lower oesophageal sphincter

Five healthy volunteers were studied for the effect on oesophageal motility of a single subcutaneous injection of a synthetic analogue of enkephalin as compared with an injection of an equivalent volume (0.5 ml) of saline. The injections were given at random on separate days, and each was followed after 40 minutes by 2 mg naloxone given intravenously. Pressures were measured by manometry after dry and wet (5 ml) swallows at one-minute intervals, and traces were coded and analysed "blind". Twenty-five minutes after the injection of enkephalin the percentage relaxation of the lower oesophageal sphincter pressure was significantly less (p less than 0.005) than at the same time after saline. Within two minutes after intravenous naloxone this effect had disappeared completely. Enkephalin had no noticeable effect on pressure of the sphincter or on amplitude and duration of oesophageal peristalsis. The mechanism of action of enkephalin in selectively inhibiting relaxation of the lower oesophageal sphincter remains to be determined. That naloxone rapidly reversed the inhibition may be relevant in achalasia and warrants further study.     

A new technique for measuring lower oesophageal sphincter competence in patients

Oesophageal sphincter measurements were carried out on 80 patients using the stationary pull through technique; Normals (n=21), Nutcracker (n=12), Refluxers (n=21), and Barrett’s (n=26). Sphincter pressure (LOSP), abdominal length of sphincter, and overall sphincter length were measured. The Sphincter Function Index (SFI) was calculated as the product of sphincter pressure and percentage sphincter length (AL) exposed to abdominal pressure. Patients also had routine endoscopy and 24 hour pHmetry. SFI values discriminated between all four groups. LOSP was significantly different for Barrett’s (p<0.01) and Nutcracker (p<0.01) compared to normals. AL was significant for Refluxers (p<0.001) and Barrett’s (p<0.001) compared to normals. SFI gives better discrimination than LOSP or AL alone and may be useful in evaluating the response to treatment.     

Clinical pharmacology and therapeutics of the oesophagus and the lower oesophageal sphincter

Oesophageal function can be studied with intraluminal manometry, indwelling pH electrodes or with in vitro methods using isolated tissue. Radiology and endoscopy are the main diagnostic procedures. Innervation of the body of the oesophagus is mainly cholinergic, but the lower oesophageal sphincter appears to be affected by a wide range of biogenic substances, such as autonomic transmitters, polypeptide hormones and prostaglandins. Most drugs used in the treatment of oesophageal disorders act by modifying the action of the naturally occurring agents.     

A型肉毒毒素对犬下食管括约肌的作用

目的:研究A型肉毒毒素(BTA)对犬下食管括约肌(LES)的作用机制,为临床BTA治疗贲门失弛缓症提供实验依据。方法:在胃镜下对BTA组(10条犬)LES分4点注射BTA,对照组(10条犬)注射生理盐水,分别于注射前、注射后1周测定LES的压力,同时测定LES中Ach的含量和AchE活性,并观察AchE阳性神经末梢和Ach囊泡的超微结构。结果:注射BTA后1周BTA组LES压力、Ach含量和AchE活性均显著低于对照组(P<0.01);在光镜下发现,运动终板色泽变淡,数目减少;在电镜下发现,神经末梢内含Ach的囊泡明显减少,末梢内AchE阳性反应物也明显减少。结论:犬LES局部注射BTA后,可引起LES压力明显下降,这可能是由于BTA破坏或抑制局部胆碱能神经末梢运动终极中的囊泡,导致局部Ach含量和AchE活性明显降低而引起。     

一氧化氮对犬下食管括约肌压力的作用

目的 :应用苄基二甲基十四烷氯化铵 (benzyldim ethyltetradecyl amm onium chloride,BAC)建立犬下食管括约肌(L ES)无神经动物模型 ,研究一氧化氮 (NO)对 L ES压力的作用。方法 :将 BAC环周注入犬 L ES,对照组注入等量生理盐水 ,均于注射前及注射后 6周测定 L ES压力 ;并观察 L -精氨酸、D -精氨酸、硝普钠及一氧化氮合酶 (NOS)抑制剂 N-硝基 - L -精氨酸 (L - NNA)对 L ES压力的影响 ;此外还测定了两组犬 L ES中 NO含量和 NOS活性。结果 :BAC处理组 L ES压力 [(4 2 .43±4.19) m m Hg,1m m Hg=0 .133 k Pa]显著高于对照组 [(2 2 .71± 5 .19) mm Hg]。 L -精氨酸可使对照组 L ES压力降低 ;L - NNA使其增高 ,但对 BAC处理组 L ES压力均无影响。硝普钠可降低两组犬 L ES压力。对照组 L ES中 NO为 (6 .0 5 8± 2 .0 6 7)μm ol/g,NOS为 (1.45 8± 0 .146 ) U /mg;而 BAC处理组 NO为 (1.797± 0 .873)μmol/g,NOS为 (0 .46 3± 0 .0 39) U /m g,均较对照组显著降低 (P<0 .0 1)。 结论 :BAC可使犬 L ES压力增高 ,其机制可能与 L ES局部 NO减少有关。     

Endoscopic sclerotherapy of bleeding oesophageal varices in Jamaica

The results of oesophageal sclerotherapy (OS) in 18 patients with recurrent bleeding varices are compared with 15 patients treated medically. The total transfusion requirement pre-sclerotherapy was 112 units of blood (mean 6/patient) which decreased to 46 units (mean 2.5) after sclerotherapy treatment was started (p = 0.005). In the medically treated group, total transfusion was 74 units (mean 5 units/patient). One hundred and forty-three injection sclerotherapy sessions were given, and all but one patient had significant reduction or eradication of varices. Three patients died of recurrent bleeding (17%) and one other required surgery. In the medically treated group, 3 patients died of bleeding (20%). Complications of sclerotherapy included mild bleeding (39%), chest pain (28%) and oesophageal ulcer (5.5%). OS reduces transfusion requirements in patients with recurrent variceal bleeding.     

Oddi括约肌测压对胆囊切除术后腹痛患者的诊断价值

探讨Ｏｄｄｉ括约肌测压对胆囊切除术后复发腹痛患者的诊断意义。用低顺应性水灌注系统。三通道测压导管，观察Ｏｄｄｉ括约肌基础压，Ｏｄｄｉ括约肌基础收缩幅度，频率，传播方式和胆管内压。结果；胆囊切除术后患者，胆总管内压无明显差异，但Ｏｄｄｉ拓约肌基础压力，Ｏｄｄｉ拓约肌基础收缩频率及度均明显增加Ｏｄｄｉ括约肌逆向性收缩的比例亦升高。     

肉毒杆菌毒素尿道外括约肌注射联合巴氯芬口服治疗脊髓损伤后逼尿肌尿道外括约肌协同失调症

目的:评价A型肉毒杆菌毒素(BTX-A)尿道外括约肌注射加巴氯芬口服治疗脊髓损伤后尿道外括约肌协同失调症(DESD)的临床效果.方法:尿流动力学检查证实脊髓损伤后DESD患者38例,男31例、女7例,平均年龄(36.5±17.8)岁.200 U BTX-A溶解于8 ml生理盐水,使用尿道镜注射针分8点二平面注射于尿道外括约肌(1 ml/点).术后第2日,随机选取12例患者(BTX-A 巴氯芬组)加服巴氯芬10 mg/次、3次/d,服用3个月,与另外26例患者作比较(BTX-A组).4周后复查尿流动力学,随访2～9个月,比较治疗前后排尿症状、尿动力学检查结果的变化,并观察毒副作用.结果:治疗后1个月,膀胱贮尿和排尿功能有不同程度改善,最大尿流率、单次尿量、最大膀胱测压容积、膀胱顺应性增加,剩余尿量及充盈末逼尿肌压力下降,差异均有统计学意义(P《0.05).BTX-A 巴氯芬组患者症状改善程度及膀胱顺应性明显优于单纯BTX-A组(P《0.05).BTX-A 巴氯芬组有3例患者因出现神经系统不良反应而停药,其余患者无明显不良反应发生.结论:BTX-A注射加巴氯芬口服可以有效改善脊髓损伤后逼尿肌尿道外括约肌协同失调症患者的排尿障碍,长期疗效尚需进一步的随访观察.     

内镜下十二指肠乳头括约肌切开取石术28例的护理

目的 探讨内镜下十二指肠乳头括约肌切开取石术患者的护理特点.方法 回顾性分析内镜下十二指肠乳头括约肌切开取石术28例患者的临床资料及护理措施.结果 28例行内镜下十二指肠乳头切开取石术全部成功:气囊或网篮取石术24例,机械碎石4例.4例结石直径大于1cm,24例结石直径小于1cm.结论 内镜下十二指肠乳头括约肌切开取石术是安全、有效的,具有创伤小、严重并发症少、术后恢复快等特点,针对患者不同情况采取有效的护理措施是保证EST 取石术成功的基础和保障.     

犬Oddi括约肌狭窄后肌电改变的实验研究

目的 探讨犬Oddi括约肌(sphincter of Oddi, SO)狭窄后其肌电活动的改变.方法 禁食16～18 h成年杂种犬全麻后,经过机械性损伤SO致其狭窄,术毕饲养,4周后再次全麻下行SO肌电测量.最后切取SO进行病理检查.结果 实验组术后4周肝功能TBIL、DBIL明显高于术前,超声测量胆总管管径大于术前,病理检查发现括约肌组织纤维化,而对照组均无明显变化.与对照组相比,实验组快波和慢波幅度均明显下降.结论 SO狭窄模型成功建立;狭窄后其电生理发生明显改变:快波和慢波幅度均下降.     

人食管下括约肌毒蕈碱受体的表达

目的：研究毒蕈碱受体亚型在人食管下括约肌（LES）套索纤维和钩状纤维的表达,对LES胆碱能收缩机制作进一步分析．方法：选取高位食管中段癌,行食管大部切除术患者12例,取食管胃接合部标本分离套索纤维和钩状纤维．分别应用逆转录聚合酶链反应（RT-PCR）和蛋白印记（Western Blot）检测5种M受体亚型在两种肌纤维中mRNA和蛋白的表达．结果：不同M受体亚型mRNA在两种肌纤维的表达有统计学差异（P〈0．05）,从数据观察5种受体亚型mRNA表达从强到弱顺序依次为M2,M3,M1,M4,M5;同一受体mRNA在两种肌纤维间表达无统计学差异;不同M受体亚型蛋白在两种肌纤维表达有统计学差异（P〈0．05）,5种受体亚型蛋白表达强弱同mRNA;同一受体在两种肌纤维间蛋白表达无差异．结论：5种M受体亚型mRNA和蛋白在两种肌纤维均有表达,M2受体表达量最高,其它依次是M3,M1,M4和M5受体;相同受体在两种肌纤维间mRNA和蛋白的表达相同．     

CCK对犬Oddi括约肌电生理影响的实验研究

目的 探讨不同剂量的胆囊收缩素(cholecystokinin, CCK) 对犬Oddi括约肌( sphincter of oddi,SO)肌电活动的影响.方法 8只成年家犬麻醉成功后,用Pull-through 法将黏膜接触电极置于SO 内,分别记录静脉注射CCK 前、注射生理剂量的CCK(20ng/kg)及大剂量的CCK(100ng/kg)后SO的肌电活动,每次记录60～80min.结果 静脉注射生理剂量的CCK后SO的慢波(slow wave of SO,SWSO)波幅降低、频率变慢,SO肌电簇(myoelectronic activity of SO,MASO)波幅也降低、频率明显变慢(P＜0.05);大剂量给予CCK后SO的慢波和肌电簇波幅都明显增高、SO肌电簇频率增快(P＜0.05).结论 生理剂量的CCK对犬SO运动具有抑制作用,导致SO处于舒张状态;增大剂量的CCK对SO的作用为兴奋作用,表现为肌电活动增强.     

正常胎儿,新生儿食管下端括约肌神经分布的观察

选用正常６－７个月胎儿尸６例，新生儿尸６例，光镜下观察食管下端，发现食管下端括约肌单位面积内神经丛和神经节细胞数一般较胃和食管部位为多，胎儿期较新生儿期多。     

喘息儿童一过性下食管括约肌松弛和酸反流的关系

目的探讨喘息儿童酸反流发病机制中一过性下食管括约肌松弛及其与胃食管返流的关系。方法选取有典型喘息症状的儿童74例行24h食管pH监测和食管测压。根据pH〈4总时间百分比〈4%且Boix-Ochoa计分〈11.99的标准,将受试者分为胃食管反流组（pH＋组）和非胃食管返流组（pH-组）。结果喘息儿童胃食管反流发生率为66.2%（49/74）,pH＋组儿童食管pH监测的各项参数均明显高于pH-组儿童。pH＋组食管下括约肌压力（LESP）明显低于pH-组[（12.1±6.8）Vs（33.5±5.6）mmHg,1mmHg=0.133kPa,P〈0.05]。pH＋组一过性LES松弛（TLESR）发生频率及TLESR持续时间明显高于pH-组[分别为（5.0±2.2）次/h Vs（2.6±1.3）次/h,（58.1±17.6）s Vs（22.7±15.4）s,均P〈0.05]。与吞咽相关的LES松弛后收缩波幅（post-LESRA）在两组间亦存在显著差别[（37.0±18.9）mmHg Vs（71.8±17.2）mmHg,P〈0.05]。结论喘息儿童酸反流发生率高,酸反流伴随TLESR发生频率增加,持续时间长。     

十二指肠在胆囊收缩素调节奥狄括约肌运动中的作用

目的制作生理状态下狗的动物模型,检验十二指肠在胆囊收缩素(cholecystokinin,CCK)调节奥狄括约肌(sphincter of Oddi,SO)运动中的作用.方法对照组6只,于十二指肠乳头对侧植入测量用造瘘套管,通过此套管放入测压管测量SO压力;十二指肠切除组6只,保留十二指肠乳头,切除十二指肠,将近端空肠与胃吻合,原十二指肠乳头与近端空肠行端侧吻合,再于吻合后的十二指肠乳头对侧植入测量用造瘘套管.静脉注入CCK,观察SO运动变化.结果当静脉注入20ng/kg CCK时,在对照组诱发SO先扩张后收缩;在十二指肠切除组SO运动与给药前比较无明显变化.当静脉注入100ng/kg CCK时,在对照组诱发SO先收缩后扩张;在十二指肠切除组诱发SO持续收缩.结论十二指肠在CCK调节SO运动中起极重要的作用.     

Does multiple injection sclerotherapy have a role in the long-term management of oesophageal varices?

Sixty-nine cirrhotic patients were treated by injection sclerotherapy for bleeding oesophageal varices, with an emergency hospital mortality, from all causes, of 29%. The treatment of 35 of these continued with elective, long-term injections alone: 9 have so far survived more than 3 years, the longest being 5 years 4 months. The risk factor for rebleeding per patient month was 0·03 and, with its minimal complications, long-term sclerotherapy can be recommended as an alternative to portasystemic shunts for all grades of liver disease.     

葡膦酰胺静脉给药对比格犬的毒性作用

目的： 评价葡膦酰胺对比格犬的安全性。方法： 观察葡膦酰胺单次静脉注射和连续静脉注射3个月对比格犬的毒性作用。结果： 葡膦酰胺单次静脉注射比格犬最低致死剂量为100 mg/kg,最高非致死剂量为50 mg/kg,近似致死剂量范围为75～100 mg/kg。连续静脉注射 20,40,60 mg/kg,每周1次,连续3个月,无严重不良反应症状,但组织病理学检查发现中、高剂量组出现广泛组织脏器损伤,低剂量组个别脏器出现轻微病理改变。结论： 在本实验条件下,40,60 mg/kg剂量葡膦酰胺每周1次,连续3个月静脉给药可造成比格犬广泛的脏器损伤。每周1次,连续3个月静脉给药剂量应低于20 mg/kg。     

胃泌素对家兔下食管括约肌及食管跨粘膜电位的影响

观察了静脉注射(ⅳ)不同剂量的五肽胃泌素(Pentagastrin,G5)对家兔下食管括约肌压力(Lower esophageal sphincter pressure,LESP)及食管跨粘膜电位(Transmucosal potential difference,PD)的影响。结果显示:ⅳGS(10μg/km)可引起LESP迅速升高和LES功能长度(Lower esophageal sphincter length,LESL)延长(P<0.01),10min左右恢复到基础水平。ⅳG5(5μg/kg)即可导致LES部位和食管中下段PD明显下降,但上段食管PD无变化。可见ⅳG5既能显著地影响食管的神经肌肉功能LESP,也能影响食管的粘膜功能PD。此外,大剂量阿托品(1mg/kg)不能完全阻断G5(20μg/kg)对LESP的影响(P<0.05),提示ⅳG5对LES的升压作用主要是它直接作用于LES的结果。