Value of investigation tests in thoracic goiters

Two groups of substernal goiters should be considered fist; the "simples" ones localised in the anterior and superior part of the mediastin. They are most common and less dangerous. By opposition to the "complexes" ones which have relation with the vessels, the airways and the digestive tube. That surgeons would like to approach with security. The study of those retrosternal goiters requires two categories of complementary examinations. One for diagnosis: X Ray standard of the neck and the chest; Echography Biopsy and Radioactive Iodine scintigraphy. Others for localisations to prevent the risks, particularly vascular seeing in the surgery of the substernal goiters: TDM and IRM.     

The surgical treatment concept in acute intestinal hemorrhage

A clinically developed and prospectively verified therapeutic concept for acute intestinal bleeding is presented in this paper. Emphasis is laid on orthograde lavage likely to enable sooner and more effective use of diagnostic means and to provide optimal conditions for surgical therapy. Prognosis can be further improved by differentiated use of therapeutic endoscopy and early elective surgery. The effectiveness of this new therapeutic concept has been successfully verified on 81 patients, between 1975 and 1986. Lethality amounted to five per cent.     

急性小肠出血的诊断分析

目的　探讨急性小肠出血的诊断方法。方法　对 17例急性小肠出血病人分别采用X线钡餐检查 ,99mTc标记的红细胞核素扫描 (ECT) ,选择性肠系膜血管造影 (DSA ) ,术中肠镜检查 ,比较各种诊断方法对判断出血部位的优劣。结果　对出血部位的定位阳性率 :ECT为 ( 7/14 )5 0 % ;DSA为 ( 8/12 ) 66.7% ,X线钡餐为 ( 3 /8) 3 7.5 %。术前不能确诊的 5例病人 ,术中肠镜均明确出血部位 ( 10 0 % )。结论　ECT和DSA有较高的诊断价值。对于术前辅助检查不能明确出血部位的病人 ,剖腹探查结合术中内镜检查是确定出血部位的关键。     

小肠镜对小肠出血的定位价值

目的 探讨小肠镜对小肠出血手术前定位的临床应用价值。方法 回顾性分析2003年6月至2004年6月通过小肠镜明确出血部位并行手术治疗的10例患者的临床资料。结果 10例患者小肠镜术前的病灶定位与术中发现的病变部位基本一致，但其中2例定性诊断不一致。结论 小肠镜对小肠出血术前定位的临床价值值得肯定，是一项安全、直观、可靠的检查手段。     

The role of emergency endoscopy in acute lower intestinal hemorrhage

The diagnostic procedures performed in patients with acute lower intestinal haemorrhage were analyzed retrospectively. During a three year period 35 patients with acute rectal bleeding were admitted and these patients underwent altogether 79 endoscopies, 7 visceral angiographies and 7 labeled red cell scintigraphies. The bleeding source was identified by endoscopy in 31 (89%) patients and remained undetermined in 4 (11%). The most common lesions responsible for the bleeding were diverticula, ischemic colonopathy and tumors. Despite the clinical impression of lower GI-tract haemorrhage 4 patients (11%) bled from the upper GI-tract. We conclude that emergency gastroscopy and colonoscopy, performed in the intensive care unit, are the procedures of choice for the investigation of the patient with acute lower GI-tract bleeding.     

Severe gastrointestinal hemorrhage in Crohn's disease.

Twenty-one of fifteen hundred twenty-six patients with Crohn's disease (CD) treated at The Mount Sinai Hospital between 1960 and 1986 developed severe gastrointestinal hemorrhage. There were 26 separate episodes of severe hemorrhage: 17 patients bled only once, three bled twice and one bled three times. The frequency of bleeding was significantly higher among patients with colonic involvement (17 of 929; 1.9%) than among those with small bowel disease alone (4 of 597; 0.7%) (p less than 0.001). Twelve patients required surgery on 13 occasions, which involved colon resection in all but one case. Eleven of these patients underwent surgery during their first hemorrhagic episodes, and 1 of 11 had a second operation for recurrent bleeding; the 12th patient, whose first hemorrhage had been treated medically, had surgery during a repeated episode of hemorrhage. The precise bleeding points could be located in only 2 of the 26 bleeding episodes, both at the ileocecal area. Three patients died, of whom two had not undergone surgery when they had bled a few weeks earlier. Primary bleeding episodes subsided without surgery in 10 of 21 cases, but 3 of these 10 patients (30%) rebled massively. By contrast primary excisional surgery was followed by recurrent hemorrhage in only 1 of 11 cases (9%). These differences in mortality and in recurrent bleeding rates, although not statistically significant, seem to favor removal of diseased bowel at the time of the first episode of massive hemorrhage.     

Severe hemorrhage intestinal in a child with ileal duplication and brief entity review

Intestinal duplications are very uncommon congenital malformations located in the mesenteric edge of the small bowel, particularly in the ileum. Over 60% of the patients become symptomatic during the first year of life whereas the remainder demonstrates symptoms at school age or adulthood. The wide spectrum of symptoms and unspecific signs frequently simulate other diseases. Gastrointestinal hemorrhage is the most noteworthy complication, which can cause severe anemia and shock. In the case we describe an 11-year-old girl experienced massive intermittent intestinal hemorrhage, anemic syndrome and intense abdominal pain over 15 months. In this patient, hemoglobin levels rose up to 6 g/dL necessitating several hemotransfusion. Multiple diagnosis and examinations were carried out until finally the gammagram with Tc99m disclosed an ectopic gastric mucosa. Using a laparotomy an intestinal duplication was found in the terminal ileum. In this paper the intestinal duplication is analyzed and the importance of considering it as a differential diagnosis in any kind of bleeding of the digestive tube is discussed.     

Diagnostic tests for intestinal ischemia.

Mesenteric ischemia is a devastating disease. Without early diagnosis and intervention, the process proceeds to intestinal gangrene with its associated high morbidity and mortality rates. Although newer operative techniques and better intensive care unit management may improve patient outcome, it is only by obtaining an earlier diagnosis that greater patient survival rates will be possible. In an attempt to improve diagnostic accuracy, many modalities have been explored. These include serum biochemical markers, peritoneal fluid analysis, tonometry, radionuclide imaging, laparoscopy, and endoscopic techniques. At present, no single test has enabled the clinician to improve the patient's outcome. We are hopeful that the newer techniques, including radionuclide-labeled antibodies, tonometry, and reflectance spectrophotometry, may in the future be of assistance in improving the results for patients sustaining intestinal ischemia.     

双气囊电子小肠镜在儿童不明原因小肠出血术前、术中定位价值

目的 探讨双气囊电子小肠镜对小肠出血手术前、手术中定位的临床应用价值.方法 回顾性分析2005年6月至2009年10月通过双气囊电子小肠镜明确出血部位并进行手术治疗的11例患儿的临床资料并进行总结.结果 11例患者小肠镜术前的病灶定位与术中发现的病变部位基本一致,术前检查所用时间为40～90 min,阳性率为85.7%,未见与操作相关的严重不良反应和并发症.结论 双气囊电子小肠镜是诊断小肠疾病较好的检查手段,在儿童中应用是安全可行的.     

Ways to improve the results of the treatment of acute gastro- intestinal hemorrhage

The work generalizes results of diagnostics and treatment of 2662 patients with acute gastrointestinal bleedings, in 1470 of them (55,3%) hemorrhages of ulcerous etiology were found. Ways to improve results of diagnostics and treatment are analyzed both at the prehospital period and in the hospital. Operations were performed on 841 patients (57%). After emergent and early urgent operations 96.5% of the patients recovered, planned operations were followed by recovery in 97.3% of the patients.