牙周病患者牙齿面磨耗状况的调查分析

目的:研究牙周病患者患牙的磨耗程度与松动度的关系。方法:选择37名牙周病患者,共710颗单根牙,记录受试牙的松动度、牙合面磨耗程度及位置。结果:牙周病患者患牙的磨耗程度与松动度有着密切的关系,多为1、2度磨耗,未见4度磨耗;牙齿不松动与Ⅱ、Ⅲ度松动的磨耗程度值间有显著差异,Ⅱ度松动、Ⅲ度松动之间无明显差异;前牙磨耗点的位置与正常牙一致,后牙磨耗点的位置呈不规则分布。结论:牙周病患者牙齿的磨耗程度较不松动牙的要低,牙松动减缓了牙齿的继续磨耗。     

PREVALENCE OF SIGNIFICANT CAROTID STENOSIS IN CHINESE PATIENTS WITH PERIPHERAL AND CORONARY ARTERY DISEASE

Background : The prevalence of extracranial carotid stenosis in the Chinese population is not known. This study aims to investigate and compare carotid disease in several groups of high-risk patients. Method : Routine screening carotid duplex scans were performed on high-risk Chinese patients without cerebrovascular symptoms. These consisted of 249 patients with peripheral vascular disease, 207 patients with coronary artery disease, and 45 patients with abdominal aortic aneurysm. In addition, 220 patients with cerebrovascular symptoms and 58 patients with carotid bruits were scanned. A group of 108 healthy individuals was included as a control. The data of all 887 subjects were analysed. Results : Carotid stenosis of 70% or greater was detected in 37.7% of patients in the cerebrovascular disease group and 24.5% of patients with peripheral arterial disease; it was higher than in patients with coronary artery disease (11.1%), asymptomatic carotid bruit (10.3%) and aortic aneurysms (8.9%; P < 0.001). No significant disease was found in the controls. Patients with cerebrovascular disease have more severe degrees of carotid stenosis and significantly more total occlusions. Smoking, age and male sex were the main risk factors for high-grade (≥ 70%) carotid stenosis. Conclusion : The prevalence of extracranial carotid stenosis in Chinese patients is not low. Patients with peripheral arterial disease have the highest risk of significant carotid stenosis: routine carotid duplex screening in these patients is recommended.     

牙周病患者牙齿牙合面磨耗状况的调查分析

目的：研究牙周病患者患牙的磨耗程度与松动度的关系。方法：选择37名牙周病患者，共710颗单根牙，记录受试牙的松动度、He磨耗程度及位置。结果：牙周病患者患牙的磨耗程度与松动度有着密切的关系，多为1、2度磨耗，未见4度磨耗；牙齿不松动与Ⅱ、Ⅲ度松动的磨耗程度值间有显著差异，Ⅱ度松动、Ⅲ度松动之间无明显差异；前牙磨耗点的位置与正常牙一致，后牙磨耗点的位置呈不规则分布。结论：牙周病患者牙齿的磨耗程度较不松动牙的要低，牙松动减缓了牙齿的继续磨耗。     

EQUALITY OF THE IN VIVO AND IN VITRO OXYGEN-BINDING CAPACITY OF HAEMOGLOBIN IN PATIENTS WITH SEVERE RESPIRATORY DISEASE

The in vivo and in vitro oxygen-binding capacity of haemoglobinwas determined on 10 occasions in nine patients who requiredmechanical ventilation. The in vitro sample was tonometeredwith 97% oxygen for 10 min and then with air, while the in vivosample was obtained after 20 min of lung ventilation with pureoxygen. Subsequent laboratory procedures were identical forboth samples. The mean oxygen-binding capacity of haemoglobinin vitro and in vivo samples were almost equal (1.365±0.010and 1.366±0.007 ml per g Hb). When the measured inactivefractions of haemoglobin (carboxy- and methaemoglobin) weretaken into account, these values increased to 1.392±0.005and 1.392±0.007 ml per g Hb respectively.     

ANTICIPATION OF END STAGE RENAL DISEASE IN PATIENTS WITH AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE IN SUCCESSIVE GENERATIONS

Autosomal dominant polycystic kidney disease is a disorder, which is inherited in 50% of offspring, irrelevant the sex and it has a variable clinical expressivity. Initially it was noticed that the clinical expression was interfamilial, but some studies found out that it was different. The aim of this study was to evaluate the age of onset of end-stage renal disease (ESRD) in affected parents in comparison with their offspring in successive generations. We studied 60 families of patients with autosomal dominant polycystic kidney disease (ADPKD). The diagnosis was done by echo criteria and we included only the patients for whom we knew precisely the onset of ESRD (affected parent and offspring), the sex of the parent who suffered from the disease, and offspring. We found out that the ESRD in ADPKD appears at the same age in affected parents and offspring (49,3 ± 7,9 Vs 51,8 ± 9,2, p = NS) irrelevant of the sex of the offspring. Patients with paternal inheritance (n = 38) were diagnosed to have ESRD earlier than their affected parents (47,9 ± 8,3 Vs 52,2 ± 9,2 p < 0,05), but patients with maternal inheritance had no difference (n = 22) (51,9 ± 6,8 Vs 51,2 ± 9,4, p = NS). In all the patients (60 couples) the survival rate was the same between affected parents and offspring (p = NS, Kaplan-Meier test), but significant differences were noticed between offspring with paternal inheritance in comparison with their parents (p < 0,05). In conclusion, we have detected that the onset of ESRD between patients with ADPKD in successive generations: a) Occurs in offspring as in their ancestors, b) anticipation was observed in 55% of couples, c) the sex of offspring does not have any relation with the renal death and d) the ESRD in patients with paternal inheritance occurs earlier in offspring than in their ancestors but not with maternal.     

STANDARDIZED CLINICAL PATHWAYS FOR ESOPHAGECTOMY ARE NOT A REALITY IN BRAZIL,EVEN WITH A HIGH PREVALENCE OF ESOPHAGEAL CANCER AND ACHALASIA

Background:

The adoption of standardized protocols and specialized multidisciplinary teams for esophagectomy involve changes in routines with the implantation of expensive clinical practices and deviations from ingrained treatment philosophies.

Aim:

To evaluate the prevalence of standardized protocols and specialized multidisciplinary teams in São Paulo state, Brazil.

Methods:

Institutions that routinely perform esophagectomies in São Paulo were contacted and questioned about the work team involved in the procedure and the presence of standardized routines in the preoperatory care.

Results:

Fifteen centers answered the questionnaire: 10 (67%) public institutions and five (33%) private. There were seven (47%) medical schools, six (40%) with a residency program and two (13%) nonacademic institutions. The mean number of esophagectomies per year was 23. There was a multidisciplinary pre-operative team in nine (60%). There was a multidisciplinary postoperative team in 11 (73%). Early mobilization protocol was adopted in 12 (80%) institutions, early feeding in 13 (87%), routinely epidural in seven (47%), analgesia protocol in seven (47%), hydric restriction in six (40%), early extubation in six (40%), standardized hospitalization time in four (27%) and standardized intensive care time in two (13%).

Conclusion:

The prevalence of standardized protocols and specialized teams is very low in Sao Paulo state, Brazil. The presence of specialized surgeons is a reality and standardized protocols related directly to surgeons have higher frequency than those related to other professionals in the multidisciplinary team.     

HAEMODYNAMIC EFFECTS OF VECURONIUM, PANCURONIUM AND ATRACURIUM IN PATIENTS WITH CORONARY ARTERY DISEASE

Thirty patients with ischaemic heart disease scheduled for coronaryartery bypass grafting were randomly allocated to three equalgroups. Following morphine, hyoscine and pentobarbi-tone premedication,anaesthesia was induced with diazepam 0.3 mg kg¹. Five minuteslater neuromuscular blockade was induced with pancuronium 0.1mg kg¹, vecuronium 0.1 mg^–1 or atracurium 0.5 mg kg^–1,followed after 6 min by fentanyl 25 µg kg^–1. Pancuroniumand atracurium caused significant increases in heart rate, whilevecuronium induced little change. Systemic vascular resistancedecreased significantly from 1515 dyn s cm^–6 to 1200 dyns cm^–5 following atracurium. Cardiac index was increasedtransiently in the atracurium group, but a more sustained increasewas observed following pancuronium. Nine patients in the atracuriumgroup showed skin flushing and one developed skin weals.     

营养支持对肝脏外科患者营养和免疫恢复促进作用的研究

目的　观察营养支持对肝脏外科患者术后机体蛋白贮备和免疫功能的影响。方法　选择肝脏外科患者2 1例 ,术后予以营养支持。肠外营养非蛋白质热卡为 2 0～ 2 5kcal/(kg·d) ,供氮 0 .15～ 0 .2 0 g/(kg·d) ,糖脂供能比为2∶1,全部营养素配制成全营养混合液 (TNA) ,经中心静脉或外周静脉输注 ,每天输注 12～ 16小时 ,连续观察 1周。在术前、术后 1、4、7天测定血浆白蛋白、转铁蛋白 (TSF)、前白蛋白 (pre Alb)和免疫指标 (IgG、IgA、IgM、IgE ,CH 5 0、C3、C4、CD3、CD4 、CD8、NKC)以及氮平衡变化。结果　术后前白蛋白及转铁蛋白均有明显下降 ,于第 4天达最低值 ,术后 7天升高 ;氮平衡变化在术后 3天内出现明显的负氮平衡 ,第 4天转为正氮平衡 ;术后免疫指标均有不同程度的下降 ,以IgG、IgE ,CH5 0、CD3、CD4 及NKC为明显 ,但术后第 7天有所回复并接近术前值 ,且高于术后第 1天水平 (P <0 .0 5 )。结论　肝脏外科患者术后行肠外营养支持是安全有效的 ,并改善了患者营养状况和免疫功能     

ARE CDX2, BETA-CATENIN AND WNT IMMUNOMARCHERS USEFUL FOR EVALUATING THE CHANCE OF DISEASE PROGRESSION OR EVOLUTION TO DEATH IN PATIENTS WITH COLORECTAL CANCER?

​ Open in a separate windowImmunomarking: intra-nuclear beta-catenin and Wnt3a     

PREVALENCE OF HELICOBACTER PYLORI INFECTION IN 160 PATIENTS WITH BARRETT’S OESOPHAGUS OR BARRETT’S ADENOCARCINOMA

Background : The role of Helicobacter pylori infection in the development of Barrett’s oesophagus and its complications is uncertain. The aim of the present study was to determine the importance of H. pylori infection in this disease by comparing the frequency of oesophageal and gastric H. pylori infection in a group of patients with Barrett’s oesophagus or adenocarcinoma, with the frequency of infection in a control group without Barrett’s disease. Methods : The study group included 160 patients (123 male, 37 female; mean age: 61.2 years) who were classified (according to the highest grade pathological lesion in the oesophagus) as having Barrett’s intestinal metaplasia (IM; 88 patients), Barrett’s oesophagus with low‐grade dysplasia (LGD; 28 patients), high‐grade dysplasia (HGD; five patients), Barrett’s indefinite for dysplasia (n = 4), and Barrett’s adenocarcinoma (33 patients). A total of 91 of these patients had gastric antral specimens available for study. The control group consisted of 214 consecutive, prospectively enrolled symptomatic patients (122 male, 92 female; mean age: 57.2 years) who underwent upper gastrointestinal endoscopy and in whom Barrett’s oesophagus or Barrett’s adenocarcinoma was not found. A modified Warthin–Starry method was used to detect H. pylori infection. Results : Oesophageal H. pylori infection was found in eight of 160 (5%) patients with Barrett’s oesophagus or Barrett’s adenocarcinoma. Helicobacter pylori organisms in the oesophagus were found only on non‐intestinalized cardiac or oxyntocardiac mucosa. All patients with oesophageal H. pylori infection and an antral biopsy available for study had antral H. pylori infection. Gastric antral H. pylori infection was significantly less prevalent in patients in the Barrett’s study group (15/91, 16.5%) than in the non‐Barrett’s control group (67/214, 31.3%; Fisher’s exact test, P = 0.01). Patients from the control group with an endoscopic diagnosis of duodenal ulcer, gastric ulcer, gastritis, or duodenitis had a significantly higher prevalence of infection compared with the Barrett’s group, but there was no difference in the infection prevalence in patients in the Barrett’s group and patients with reflux oesophagitis, hiatal hernia, no endoscopic abnormality, or any other diagnosis. Conclusions : Oesophageal H. pylori infection is uncommon in patients with Barrett’s IM, dysplasia, or adenocarcinoma, and may be restricted to non‐intestinalized columnar epithelium. Gastric H. pylori infection may have a protective effect for the development of Barrett’s oesophagus.     

INFLUENCE OF EXERCISE TESTING IN GASTROESOPHAGEAL REFLUX IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE

Background

Gastroesophageal reflux disease is a worldwide prevalent condition that exhibits a large variety of signs and symptoms of esophageal or extra-esophageal nature and can be related to the esophagic adenocarcinoma. In the last few years, greater importance has been given to the influence of physical exercises on it. Some recent investigations, though showing conflicting results, point to an exacerbation of gastroesophageal reflux during physical exercises.

Aim

To evaluate the influence of physical activities in patients presenting with erosive and non erosive disease by ergometric stress testing and influence of the lower esophageal sphincter tonus and body mass index during this situation.

Methods

Twenty-nine patients with erosive disease (group I) and 10 patients with non-erosive disease (group II) were prospectively evaluated. All the patients were submitted to clinical evaluation, followed by upper digestive endoscopy, manometry and 24 h esophageal pH monitoring. An ergometric testing was performed 1 h before removing the esophageal pH probe. During the ergometric stress testing, the following variables were analyzed: test efficacy, maximum oxygen uptake, acid reflux duration, gastroesophageal reflux symptoms, influence of the lower esophageal sphincter tonus and influence of body mass index in the occurrence of gastroesophageal reflux during these physical stress.

Results

Maximum oxigen consumption or VO 2 max, showed significant correlation when it was 70% or higher only in the erosive disease group, evaluating the patients with or without acid reflux during the ergometric testing (p=0,032). The other considered variables didn''t show significant correlations between gastroesophageal reflux and physical activity (p>0,05).

Conclusions

1) Highly intensive physical activity can predispose the occurrence of gastroesophageal reflux episodes in gastroesophageal reflux disease patients with erosive disease; 2) light or short sessions of physical activity have no influence on reflux, regardless of body mass index; 3) the lower esophageal sphincter tonus does not influence the occurrence of reflux disease episodes during exercise testing.     

胆囊结石患者血浆、胆汁及胆囊组织中胃动素和血管活性肠肽的变化及意义

目的 探讨胃动素（MOT）及血管活性肠肽（VIP）与胆囊结石形成的关系。方法 收集48例胆囊结石患者术前及术后1、3、7天血浆和胆囊组织，胆汁，采用放射免疫法测定其MOT和VIP含量。结果 胆囊结石患者术前及术后血浆MOT水平明显升高；胆囊组织及胆汁中MOT、VIP水平均明显升高，且胆囊组织中MOT与VIP呈明显正相关。结论 MOT和VIP可能通过改变胆囊的运动而促进了胆囊结石的形成。     

THE VALUE OF TECHNETIUM-99M RENOGRAPHY FOR THE DETECTION OF RENAL ARTERY STENOSIS IN PATIENTS WITH AORTIC AND LOWER LIMB VASCULAR DISEASE

The results of technetium renography were compared with arteriography to determine whether this is a satisfactory screening test for renal artery stenosis (RAS). Sixty-three patients were studied before aortic surgery. All were investigated by aortography and isotope renography. These tests were assessed blind and all arteriograms were graded by a single independent radiologist. Renal artery stenosis was detected by arteriography in 34 (54%) patients. Twenty-three (37%) had mild (< 50%) stenosis, seven (11%) had moderate (50–80%) stenosis and four (6%) had severe (> 80%) stenosis. Of these 34 patients, only 6 (18%) were correctly diagnosed by isotope renography. None of the four with severe stenosis were identified. Isotope renography resulted in six true positives, six false positives, 23 true negatives and 28 false negatives. It was concluded that isotope renography did not fulfil the criteria for a screening test for the detection of RAS and appeared to be of no value in those patients undergoing aortic surgery in whom arteriography was not indicated.     

MORBIDITY AND MORTALITY AFTER ABDOMINAL AORTIC SURGERY IN A POPULATION OF PATIENTS WITH HIGH CARDIOVASCULAR RISK

Postoperative myocardial infarction is a major risk factor in patients undergoing abdominal aortic surgery. Correction of cardiac ischaemia prior to abdominal aortic surgery improves outcome. The morbidity and mortality of 639 consecutive patients were reviewed from an area with poor access to cardiac surgery, operated upon in a single tertiary referral hospital for aortic aneurysm or aortobifemoral grafting. A total of 101 patients with ruptured aortic aneurysm who survived to reach the intensive care unit experienced a hospital mortality of 29%. Multiorgan failure was the cause of death in 48% and postoperative myocardial infarction in 31%. Of the 253 patients with intact aortic aneurysm, which included elective and urgent resection, the mortality was 9%. There was a high incidence of uncorrected pre-operative ischaemic heart disease and myocardial infarction was the major cause of death (62%). Pre-operative myocardial infarction was predictive of postoperative cardiac morbidity and mortality. Of the 285 patients undergoing aortobifemoral grafting the mortality was 3% despite a high incidence of pre-operative ischaemic heart disease. Further reductions in postoperative death from ruptured aortic aneurysm must await improved screening to diagnose and treat the aneurysm before rupture. In patients operated upon electively, improved pre-operative cardiac screening and coronary bypass grafting where appropriate, especially for patients with aortic aneurysm and previous myocardial infarction, may further reduce pen-operative mortality.     

胰体尾癌（附112例报告）

本文报告112例胰体尾癌,均经BUS、CT、ERCP以及剖腹探查术确诊。胰体尾癌出现症状至确诊时间3~4个月,其中111例因延误早期诊断而发展为进展期癌,仅1例为早期胰体尾癌。作者认为凡有上腹痛、腰背痛及食欲不振症状者,应警惕早期胰癌的存在。应用BUS、CT、ERCP进一步检查,必要时行细针穿刺细胞学检查及剖腹探查术均可确诊。本组105例不能切除,仅7例能切除,切除率极低,但早期诊断,力争早期根治性切除胰体尾癌,效果是理想的。     

肝包虫病的鉴别诊断与术式选择(附48例报告)

为提高肝包虫病的诊治水平，对我院１９８７～１９９７年１０年间收治的４８例肝包虫病患者进行了回顾性研究，着重对该病的鉴别诊断和术式选择进行讨论，分析了误诊原因，评估了各种术式并改进手术的方法和技巧，结果：病史含糊，症状不明显，免疫学试验误差，影像学检查缺乏特征性表现或以合并症为首发症状是常见的误诊原因，术式选择须因病制宜，灵活掌握，“无瘤”操作，高渗盐水冲洗，网膜堵塞和生物胶的应用等手术技巧的改进可     

HISTOLOGICAL COMPARISON OF THE THIRD INTERDIGITAL NERVE IN PATIENTS WITH MORTON'S METATARSALGIA AND CONTROL PATIENTS

This study compares the histology of the plantar-digital nerve supplying the third web space in asymptomatic patients with those who have clinically diagnosed Morton's metatarsalgia. Despite several studies concentrating on the histological changes in the interdigital nerve, the relevance of these changes is a matter of contention while the exact pathological process responsible for the symptoms has not been determined. The histological findings in control patients were identical to Morton's patients with the exception of demyelination, which was more common in the Morton's group. This suggests that the characteristic nodule and fibrotic changes seen in the interdigital nerves of patients with Morton's neuroma cannot account for the symptoms and that the changes seen in the neurovascular bundle are degenerative in origin and are found in asymptomatic patients.