过敏性紫癜并发急性胰腺炎12例诊疗体会

我院 2 0 0 0年 1月～ 2 0 0 2年 6月收治过敏性紫癜 176例 ,其中 12例 (6 8% )并发急性胰腺炎。报告如下。1　临床资料1 1　一般资料　本组 12例中 ,男 7例 ,女 5例 ;年龄 4～ 12岁 ;病程 10～ 2 1天。1 2　临床表现　 12例均有皮肤紫癜 ,为双下肢和臀部对称分布之紫红色出血性皮疹 ,稍隆起表皮 ;均有上腹痛 ,其中呕吐 10例 ,恶心 6例 ,腹胀 7例 ,伴消化道出血、发热各 4例 ,关节肿痛 2例 ,肾脏受累 3例 ,肠穿孔 1例。1 3　医技检查　血小板、出凝血时间均正常 ,6例血白细胞 (11 0～ 2 4 6 )× 10 9/L ,5例嗜酸细胞 0 0 5～ 0 12 ,10…     

胃镜诊断胃癌412例分析

目的通过内镜检查了解山区农民胃癌发病情况。方法 1170 4例患者内镜检查资料。结果查出胃癌 412例 ,占 3.5 % ,其中早期胃癌 5例 ( 1.2 % ) ;进展型胃癌 40 7例。男多于女 ( P<0 .0 1) ;农民 40 1例 ( 97.3% ) ,干部职工 11例 ( 2 .7% )。结论磐安县胃癌发病主要是农民 ,中老年多 ,进展型胃癌为主 ,应放宽内镜检查的适应症 ,对 5 0岁以上患者应重视 ,检查中对可疑病变及时活检 ,以期早期诊治疗     

成人全大肠镜用于儿童便血的诊治体会

目的 探讨成人纤维大肠镜对儿童便血的诊断和治疗的可行性。方法 回顾性分析96例儿童便血的结肠镜检查及治疗资料。结果 发现病变92例，明确诊断率为95.8%，其中大肠息肉64例，大肠炎17例，溃疡性结肠炎4例，肛周疾病4例，阿米巴感染2例，血管瘤1例。未见异常4例。64例大肠息肉患者经内镜电切息肉92颗，术后仅1例出现迟发性肠出血，其余未见肠穿孔等严重并发症。结论 成人纤维大肠镜应用于儿童便血检查不仅诊断率高，且具有内镜下诊断和治疗的双重作用。大肠镜检查是儿童便血首选的检查方法。     

食管乳头状瘤研究分析

目的 探讨食管乳头状瘤的内镜、临床病理特点。方法 对25例食管乳头状瘤的胃镜、病理及临床资料进行回顾性总结分析。结果 食管乳头状瘤好发于食管中下段，食管上1／3有1例(4％)，中段11例(44％)，下段13例(52％)，食管中下段24例(96％)；内镜下易误诊为食管息肉，11例内镜下治疗后随访6～36个月未见复发，3例并发其他部位肿瘤；病理学检查未见食管乳头状瘤恶变依据，仅有3例轻到中度异型增生；食管乳头状瘤临床表现无特异性，与反流性食管炎相似。结论 黏膜的慢性炎症刺激等因素在食管乳头状瘤的发病中起一定作用；加强对食管乳头状瘤病人邻近脏器的检查和随访非常重要；食管乳头状瘤是否为癌前病变值得进一步研究。     

ERCP引发急性胰腺炎的高危因素探讨

目的　探讨与ERCP(内镜下逆行胰胆管造影 )引发急性胰腺炎有关的高危因素。方法　对该院2 0 0 0年 1月～ 2 0 0 2年 12月行ERCP检查或治疗的 380例患者进行回顾性分析 ,用单变量分析相关的危险因素。结果　 17例于ERCP后发生急性胰腺炎 ( 4 .4 % ) ,380例中 2 80例为治疗性 ,15例并发急性胰腺炎( 4 .8% ) ,10 0例为诊断性 ,2例并发急性胰腺炎 ( 2 .0 % ) ,与ERCP引发急性胰腺炎相关的主要因素有 :内镜下括约肌切开 (EST) ,针状刀预切开乳头 ,多次乳头插管 ,胰管深插 ,多次胰管造影 ,导引钢丝辅助插管 (P <0 .0 5 ) ,高危人群为奥狄氏括约肌功能障碍者 ,有胰腺炎病史者。结论　治疗性ERCP较诊断性ERCP易并发急性胰腺炎 ,急性胰腺炎的发生主要与技术操作有关 ,娴熟的内镜技术 ,严格掌握指征可降低发生率。     

食管癌术后并发肺不张26例分析

1996年 1月至 2 0 0 2年 6月 ,我们行食管癌手术共 5 12例 ,术后并发肺不张 2 6例 ,发生率 5 .1%(2 6 /5 12 ) ,现分析如下。1　临床资料1.1　一般资料　本组 2 6例 ,男 15例 ,女 11例。年龄 4 0～ 71岁 ,平均 6 1岁。术前合并慢性支气管炎 9例 ,合并营养不良 8例。本组肺不张发生于食管癌手术后 2～ 5天 ,均经X线检查证实。其中 ,胸下段食管癌 14 4例 ,取左胸单切口食管癌切除胃食管弓下吻合术 ,并发肺不张 6例 (4 .2 % ) ;胸中段、中下段食管癌 32 2例 ,取左侧颈胸二切口食管癌切除胃食管颈部吻合术 ,并发肺不张 16例 (4 .9% ) ;胸中上段…     

内镜下血管钳夹加止血合剂注射治疗难治性溃疡出血的护理64例

1998年 1月～ 2 0 0 2年 12月 ,我院采用内镜下血管钳夹加止血合剂注射治疗难治性溃疡出血6 4例 ,止血效果较好 ,现报告如下。1　临床资料1.1　一般资料本组 6 4例患者 ,男 4 1例 ,女 2 3例 ,年龄 18～6 4岁 ,平均年龄 37.6岁。其中十二指肠球部溃疡并出血 4 5例 ,胃溃疡并出血 12例 ,复合性溃疡并出血 7例 ;呕血 2 4例 ,失血性休克 38例 ,大出血5 2例。病例选择标准 :(1)病史、体征、内镜检查诊断胃或 /和十二指肠球部溃疡 ,用H2 受体拮抗剂标准剂量治疗 3个月 ,溃疡未愈合 ;(2 )急诊内镜检查确诊为消化性溃疡并出血。1.2　方法作急诊内镜…     

幽门梗阻患者食管炎临床及内镜特征观察

幽门梗阻临床上仍较常见,因受原发病严重症状的影响,其并发的反流性食管炎并未引起临床医师的重视,报道很少。现将我院6年来经内镜检查确诊的48例幽门梗阻食管炎患者的临床及内镜特征分析报道如下。1！闲床资料1．1一般资料男39例、女9例,年龄22－78岁,平均45岁。引起幽门梗阻原因：球溃疡25例,幽门管及胃窦部溃疡12例,胃窦部恶性肿瘤11例。均有反复呕吐。呕吐持续7天一3月,2周内8例,2－4周Zo例,4周以上ZO例。所有幽门梗阻者均有内镜下食管炎表现。1．2反流性食管炎临床症状刀例（64．6％）有症状,门例（35．4％）无症状。反酸…     

内镜下微波加注射治疗Dieulafoy病的体会

我院经急诊内镜检查的7例Dieulafoy病(亦称胃粘膜下恒径动脉破裂出血),其中5例经内镜微波加注射止血治疗有效,2例手术治疗,现报道如下。 1资料与方法 1.1一般资料 1992～1997年底急诊内镜检出的Dieulafoy病7例,占同期各种原因上消化道出血内镜检查患者的0.91％。本组7例均为男性,年龄26～67岁,平均年龄39.4岁。均无明显诱因突然大量呕血及(或)黑便入院。其中表现为呕血者6例(85.71％),呕血伴黑便4例(57.14％),伴失血性休克5例(71.42％)。 1.2内镜检查 7例均急诊内镜检查,发现病变在胃体小弯后壁3例,胃底后壁2例,胃窦大弯侧1例,十二指肠球部1例。病变于镜下为0.5～2.0cm浅表性溃疡5例,小片状粘膜糜烂2例。病变处活动性喷射状出血(Forrest Ⅰa)4例,血管显露(ForrestⅡa)3例。     

内镜下逆行胰胆管造影术后并发急性上 消化道出血的急诊内镜诊疗

目的 分析内镜下逆行性胰胆管造影（ERCP）术后并发急性上消化道出血的临床表现和急诊内镜诊疗情况。方法 回顾性分析2007年9月-2012年9月于该科行ERCP 753例患者资料,其中并发急性上消化道出血8例。表现为黑便和（或）呕血,于ERCP术后1~3 d发生。7例行急诊内镜检查,5例行内镜下止血治疗,2例无需内镜止血治疗,另1例拒绝内镜检查给予抑酸治疗。结果 8例患者完全成功止血。结论 ERCP术后并发急性上消化道出血相对少见,但部分患者出血严重,急诊内镜诊疗简便、有效。     

大肠正常组织和癌组织自体荧光差异病理学基础

目的：比较胶原Ⅰ、Ⅲ、Ⅳ型在大肠正常组织和癌组织的分布差异,分析组织癌变后胶原的改变对自体荧光产生的影响。方法：采用免疫组化技术,半定量计分分析Ⅰ、Ⅲ、Ⅳ型胶原亚型在２６例病人正常和腺癌组织中的分布差异。结果：正常组织的基底膜呈现很强的Ⅳ型胶原抗体阳性反应,在基底膜形成较粗的环形染色带;Ⅰ型和Ⅲ型胶原抗体反应在细胞外基质呈连续的细丝纤维样,紧贴基底膜,间质中染色较基底膜稍深。癌组织Ⅳ型胶原抗体反应在癌巢周边为阴性,或仅在残存的基底膜有片断的阳性反应;Ⅰ型和Ⅲ型胶原在癌巢周边的反应呈阴性或不连续性的阳性,但癌间质的阳性反应较正常间质内明显。癌细胞浸润深肌层后癌巢周边间质内三种胶原抗体反应均呈阴性。Ⅰ型、Ⅲ型和Ⅳ型在正常组织和癌组织中的分布存在十分显著性差异（Ｐ〈０．００１）,但在不同分化程度腺癌的分布上无明显差异     

Changes in distribution of connective tissue components of human placentae with maturation

The distributional changes of type IV collagen and laminin with normal maturation of human placentae were examined in relation to those of fibronectin by the histochemical methods including immunofluorescence staining. In the early chorionic villi, these components were detected along the trophoblastic basement membrane, around the fetal blood vessels, and in the villous stroma. Laminin was detected also in the pericellular matrices of nonvillous cytotrophoblasts where type IV collagen was rarely detected. In the late and term placentae, laminin and type IV collagen were detected along the trophoblastic basement membrane, while this structure was virtually not stained for fibronectin. These observations suggest that type IV collagen and laminin are the constituents of the trophoblastic basement membrane throughout the maturation period of the placentae, while fibronectin is a transient constituent.     

Role of basement membrane collagen and elastin in the autofluorescence spectra of the colon.

BACKGROUND: Autofluoresence can be used to detect neoplasia in the colon. Two known fluorophores, collagen and elastin, are probably partly responsible for colonic emission spectra. Their contribution to colonic autofluorescence was investigated. METHODS: Autofluorescence spectra of normal, dysplastic, and malignant colonic tissue were studied by using excitation wavelengths from 280 nm to 350 nm. The wavelengths of peak emission and their widths at half maximum intensity were measured. Similar measurements were performed on collagen types I, III, IV, V, IX, and elastin. Colonic spectra were compared to those of collagen and elastin. Spectral differences between collagen types IV (basement membrane) I, III, V, and IX were studied. RESULTS: Four major emission peaks were noted whose wavelength of peak emission and full widths at half maximum intensity were independent of tissue histology. The emission spectra of type IV collagen differed markedly from that of nonbasement membrane collagens and elastin. CONCLUSIONS: Type IV (basement membrane) collagen is most likely responsible for the emission peak at 365 nm. The spectra of basement membrane collagen and not other types of collagen should be used in studies of epithelial tissue spectra. Elastin did not appear to be responsible for any of the four autofluorescence peaks observed in colonic tissue.     

Changes in the collagen of synovial membrane in rheumatoid arthritis and effect of D-penicillamine.

1. Normal synovial membrane contains approximately equal proportions of two genetically distinct forms of collagen, types I and III. The proportion of these two collagens is unchanged in rheumatoid synovium but in addition a small amount of basement membrane collagen is present. Tissue culture of rheumatoid synovium confirms the synthesis of both type I and III collagens. 2. In young normal synovium both type I and type III collagens are stabilized by a reducible keto cross-link, which is replaced in adult tissue by an as yet unknown non-reducible cross-link. During the proliferation of the collagen in adult rheumatoid synovium a high proportion of the keto cross-link is present. This cross-link is not susceptible to cleavage by D-penicillamine, nor does the drug have any effect on the rate of synthesis in vitro. The mode of action of D-penicillamine in rheumatoid arthritis does not appear to involve a direct effect on the synovial membrane collagen.     

Rheumatic fever-associated Streptococcus pyogenes isolates aggregate collagen

Acute rheumatic fever is a serious autoimmune sequel of Streptococcus pyogenes infection. This study shows that serotype M3 and M18 S. pyogenes isolated during outbreaks of rheumatic fever have the unique capability to bind and aggregate human basement membrane collagen type IV. M3 protein is identified as collagen-binding factor of M3 streptococci, whereas M18 isolates bind collagen through a hyaluronic acid capsule, revealing a novel function for M3 protein and capsule. Following in vivo mouse passage, conversion of a nonencapsulated and collagen-binding negative M1 S. pyogenes into an encapsulated, collagen-binding strain further supports the crucial role of capsule in mediating collagen binding. Collagen binding represents a novel colonization mechanism, as it is demonstrated that S. pyogenes bind to collagen matrix in vitro and in vivo. Moreover, immunization of mice with purified recombinant M3 protein led to the generation of anti-collagen type IV antibodies. Finally, sera from acute rheumatic fever patients had significantly increased titers of anti-collagen type IV antibodies as compared with healthy controls. These findings may suggest a link between the potential of rheumatogenic S. pyogenes isolates to bind collagen, and the presence of collagen-reactive autoantibodies in the serum of rheumatic fever patients, which may form a basis for post-streptococcal rheumatic disease. These anti-collagen antibodies may form a basis for poststreptococcal rheumatic disease.     

Type IV and type "A-B" collagens do not elicit platelet aggregation or the serotonin release reaction.

Human collagens were isolated from kidney, lung, skin, aorta, cartilage, and placenta. Five different types were obtained, including two new molecular species, one characteristic of basement membranes, or type IV collagen, and the other the recently described "A-B" collagen derived from fetal membranes. All the collagens were purified and separated by combination of heat-gelation fractionation and salt fractionation. In neutral solution at 37 degrees neither type IV nor type "A-B" collagen elicited platelet aggregation or 14C-serotonin release. Preincubation of platelets with both types IV and "A-B" collagen did not inhibit aggregation upon subsequent addition of collagen types I, II, or III.     

Extracellular matrix gene expression increases preferentially in rat lipocytes and sinusoidal endothelial cells during hepatic fibrosis in vivo.

Whether parenchymal or nonparenchymal liver cells play a predominant role in the pathophysiology of hepatic fibrosis has not been firmly established in vivo. We have addressed this question by quantitating the relative abundance of specific mRNAs for collagen types I, III, and IV, and laminin in purified populations of hepatocytes, sinusoidal endothelial cells, and lipocytes from normal and fibrotic rat liver. In normal liver, type I collagen gene expression was minimal in all cell types; mRNA for types III and IV collagen were apparent in endothelial cells and lipocytes, but not in hepatocytes. Laminin mRNA was present in all cell types. Induction of fibrogenesis by either bile duct ligation or carbon tetrachloride administration was associated with a substantial increase in mRNA for types I and III collagen in nonparenchymal cells. Lipocytes from fibrotic animals exhibited a greater than 30-fold increase in type I collagen mRNA relative to normal lipocytes, and greater than 40-fold relative to hepatocytes. Type III collagen mRNA reached 5 times that in normal lipocytes and greater than 120 times that in hepatocytes. Endothelial cells exhibited an isolated increase in type I collagen mRNA, reaching five times that in normal liver. Type IV collagen and laminin gene expression were not significantly increased in nonparenchymal cells during fibrogenesis; in fact, mRNA for type IV collagen and laminin decreased by up to 50% in endothelial cells. Despite the pronounced changes that occurred in matrix gene expression in nonparenchymal cells during fibrogenesis, no change was noted in hepatocytes. We conclude that nonparenchymal liver cells, particularly lipocytes, are important effectors of hepatic fibrosis in vivo.     

Amyloid P-component is a constituent of normal human glomerular basement membrane

Glomerular and other vascular basement membranes were found to contain an antigen that was immunochemically indistinguishable from serum amyloid P-component. There was no immunological cross-reactivity between antisera to serum amyloid P-component and to collagen types I, III, IV, or V. The amyloid P-component antigen was confined to the endothelial aspect, the lamina rara interna, of glomerular basement membrane. It could not be eluted by high-ionic-strength saline, EDTA, dithiothreitol, or either polar or nonpolar detergents, but was released into solution when isolated glomerular basement membrane was digested by highly purified bacterial collagenase. Most of these P- component molecules and their constituent polypeptide chains were of higher molecular weight and lower isoelectric point than serum amyloid P-component. These findings indicate that, as well as being a normal plasma protein and a universal constituent of amyloid deposits, P- component is also a normal matrix glycoprotein of basement membrane in which it is covalently linked to collagen and/or other matrix proteins. This may be relevant both to the pathogenesis of amyloidosis and to other aspects of physiology and pathology of basement membranes.     

Collagen type IV and procollagen type III during granulation tissue formation: a serological, biochemical, immunohistochemical and morphometrical study on the viscose cellulose sponge rat model

The serum concentrations of collagen type IV,7S, collagen type IV,nc1, and aminoterminal type III procollagen peptide immunoreactive components were measured by means of specific radioimmunoassays during development of granulation tissue in rats. The results were compared with tissue deposition of basement membranes and interstitial collagens in the granulation as measured morphometrically. A parallel sequential pattern in tissue deposition of collagen types III and IV, and serum increase of collagen types III- and IV-related fragments, was observed. Serum collagen type IV was less sensitive as a marker for development of granulation tissue than the serum procollagen type III N-peptide. This was in accordance with a low collagen type IV/interstitial collagen ratio in the granulation tissue. However, a cross-sectional study showed that serum collagens types IV,7S and IV,nc1 may be useful as early quantitative indicators of granulation tissue formation. Simultaneously, measurement of collagen type IV- and procollagen type III N-peptide-related antigens in serum provides a differentiated reflection of the dynamic matrix processes in developing granulation tissue.     

Colorectal cancer metastatic phenotype stimulates production by fibroblasts of N-terminal peptide of type III collagen: clinical implications for prognosis

In this study we assessed whether the serum levels of the N-terminal peptide of type III collagen (PIIIP), an index of type III collagen synthesis, are influenced by colorectal cancer stage, and whether "in vitro" fibroblast growth and PIIIP production could be altered by tumor tissues obtained from metastatic and nonmetastatic colorectal cancer. 208 colorectal cancer patients (115 colon and 93 rectum) were studied; 54 were stage I, 62 stage II, 37 stage III and 55 stage IV. PIIIP serum levels were significantly higher in stage IV as compared to all other patient groups. The 5-year survival of stage I, stage II, stage III and stage IV patients were 87%, 88%, 32% and 20%, respectively. In the subgroup of stage I and stage II patients considered together, PIIIP (> 0.5 U/ml), but not CEA (> 5 microg/l) serum levels, were predictive for survival. Fibroblast growth was significantly inhibited, while PIIIP production was significantly enhanced, when these cells were conditioned with colorectal cancer homogenates obtained from patients with distant metastases, than from those without distant metastases. In conclusion, colorectal tumors, when metastatic, stimulate fibroblasts' PIIIP synthesis and the serum levels of this peptide might predict patients' outcome after radical surgery.