快速尿素酶法诊断幽门螺杆菌感染及分布

本实验对接受胃镜检查的255例患者采取胃粘膜,以快速尿素酶法作幽门螺杆菌(HP)检查。患者中男性201例,女性54例。年龄17～74岁,平均35岁。每例受检者均取胃窦、胃体粘膜2块,分别以快速尿素酶法作HP检测和组织病理学检查;另有13例十二指肠球溃疡者加取十二指肠球粘膜一块并作HP检查。结果显示,154例HP阳性者中139例胃窦、体一致,15例不一致。9例分多处活检粘膜HP检查结果一致,提示HP感染呈弥漫性,在胃内任一部位取材即有一定代表性。另外,本组13例十二指肠球溃疡中11例胃粘膜HP阳性,而十二指肠球粘膜仅3例阳性、提示十二指肠球粘膜不易感染HP。     

小儿胃十二指肠溃疡X线征象

目的:探讨小儿胃十二指肠溃疡的X线征象.方法:搜集经手术证实的54例胃十二指肠溃疡患儿的钡餐检查资料,年龄11天～14岁,平均10.4岁,其中男女之比约为2:1.分析小儿胃十二指肠溃疡的临床及X线表现.结果:54例中,胃溃疡6例(11%),十二指肠溃疡47例(87%),复合溃疡1例(2%).胃溃疡X线表现为龛影,黏膜改变,胃窦痉挛、狭窄及排空延迟.十二指肠溃疡X线表现为龛影,球部变形、黏膜改变、幽门管偏移、球部激惹征.结论:传统X线钡餐可诊断小儿胃十二指肠溃疡,其X线征象具有一定特异性.     

胃和十二指肠线形溃疡8例报告

在以往的教科书中，把圆形或椭圆形壁龛作为胃和十二指肠溃疡的主要X线征象，反映了大多数病例的实际情况，但对其它较少见形态的壁龛常被忽视，近年来随着上消化道双对比造影技术的推广，对壁龛形态表现不典型的胃和十二指肠溃疡包括线形溃疡的诊断率日益提高，我们对本院收治的胃线形溃疡7例和十二指肠球部线形溃疡1例报道如下。供同道们参考。     

口服速溶型助显剂在胃肠超声造影检查胃十二指肠疾病诊断中的应用

目的探讨口服速溶型助显剂在胃肠超声造影检查胃十二指肠疾病诊断中的应用。方法对85例患者进行胃肠超声造影检查与胃镜病理检查对照分析。结果胃肠超声造影检出各类胃炎60例,胃十二指肠溃疡10例,胃癌8例,胃间质瘤1例,胃息肉2例,胃下垂4例。超声造影检查与胃镜病理检查符合率约90％。结论口服速溶型胃肠超声造影检查对胃炎、胃十二指肠溃疡、胃癌有一定的诊断价值,可作为胃镜、X线钡餐造影的互补检查方法。     

上消化道腐蚀性烧伤的X线造影分析

上消化道腐蚀性烧伤是指由于误服或有意吞服强酸、强碱等化学腐蚀剂而引起的食管、胃及十二指肠的灼伤。X线造影是其主要检查手段，能清晰显示病变范围及程度，具有较强的特异性。本文收集16例进行回顾性分析，以探讨X线造影对上消化道腐蚀性烧伤的临床价值。     

十二指肠球部溃疡继发胆总管瘘1例报告

十二指肠——胆总管瘘较少见,胆石症是胆——胃肠内痿的主要原因,溃疡继发十二指肠——胆道瘘尤为罕见,我们发现一例,现报告如下: 患者,男,36岁,上腹部不适,呕吐反复发作两年,来我科行上消化道钡餐检查。 X线所见:胃内无潴留液,胃窦部幽门前区粘膜增粗,紊乱,十二指肠球部变形。边缘毛糙,密度不     

双对比钡餐检查胃线形溃疡6例报告

在以往的教科书中，把圆形或椭圆形龛影作胃、十二指肠溃疡的主要X线征象，反映了大多数病例的实际情况。但对其它较少见形态的龛影常被忽视。近些年来随着上消化道双对比造影技术的推广对龛影的形态表现不典型的胃线形溃疡的诊断日益提高。现对我院近期收治的胃线形溃疡6例报告如下，共同行们参考。     

胃和十二指肠异位胰腺X线造影表现(附5例报告)

目的 评价X线钡餐造影诊断胃和十二指肠异位胰腺的价值.方法 对5例胃镜或病理证实的异位胰腺X线钡餐造影表现进行回顾性分析.结果 异位胰腺位于胃3例(胃和十二指肠2例,胃体1例),胃幽门前区十二指肠球部2例.钡餐检查3例表现为肿块型,"脐样征"阳性,肿块呈圆形或卵圆形,边界清楚,表面有脐样钡斑;2例表现为"导管征"阳性.肿物大小约1.5～3.5 cm.结论 "脐样征"和"导管征"是异位胰腺特征性X线表现,正确认识有助于确诊.     

胃线形溃疡X线诊断(附16例报告)

本文报告16例经胃低张双对比造影和胃镜证实的胃线形溃疡.X线表现为胃轮廓畸形,线形龛影,粘膜皱襞呈放射状向龛影集中。壁龛长0.8～3.6cm,宽0.1—0.3cm.胃小弯、胃体后壁与胃窦好发。 结合胃镜与X线追踪观察认为线形溃疡为圆形溃疡修复的演变,或一开始即呈线形溃疡。同时对线形溃疡与溃疡瘢痕的区别做了讨论。     

士兵幽门螺杆菌感染与胃疾病红细胞免疫功能变化的关系

 目的探讨士兵幽门螺杆菌感染与胃十二指肠疾病红细胞免疫功能变化的关系.方法采用花环法测定红细胞C3b受体花环率(RBCC3bRR)及免疫复合物花环率(RBCICR),对士兵HP阳性和HP阴性的95例慢性胃炎和31例十二指肠球部溃疡患者及30例健康士兵进行红细胞免疫功能检测.结果HP感染越重,慢性胃炎炎症程度也越重;慢性胃炎和十二指肠球部溃疡的RBCC3bRR,分别低于正常组(P＜0.01),RBCICR分别高于正常对照组(P＜0.05或P＜0.01),提示患者红细胞免疫功能降低;HP阴性慢性胃炎与HP阴性十二指肠球部溃疡、HP阳性慢性胃炎与HP阳性十二指肠球部溃疡分别比较RBCC3bRR和RBCICR无显著性差异.提示,红细胞免疫功能降低与疾病种类无关;慢性胃炎中HP阳性RBCC3bRR明显低于HP阴性者,RBCICR明显高于HP阴性者(P＜0.01),十二指肠球部溃疡中HP阳性与HP阴性间亦有此规律,但无统计学意义;75例HP阳性者RBCC3bRR明显低于51例HP阴性者,(P＜0.05),RBCICR明显高于HP阴性者(P＜0.01);HP根除后慢性胃炎和十二指肠球部溃疡患者RBCC3bRR,分别较治疗前明显升高(P＜0.05或P＜0.01).RBCICR分别较治疗前明显降低(P＜0.01).结论HP感染、慢性胃炎、十二指肠溃疡均可降低红细胞免疫功能,尤其是HP感染.     

Enlarged gastric folds in association with Campylobacter pylori gastritis

Enlarged gastric folds in pediatric patients are uncommon. Fifteen patients with upper gastrointestinal (GI) tract symptoms of chronic epigastric abdominal pain, vomiting, or hematemesis underwent radiologic upper GI barium studies and were found to have Campylobacter pylori gastritis at endoscopic biopsy. Seven patients (47%) with C pylori gastric disease had radiologic evidence of enlarged folds. There was no clinical or pathologic evidence of Ménétrier disease. Therefore, C pylori gastritis should be considered in the differential diagnosis of children with upper GI tract symptoms and radiologic evidence of enlarged folds.     

Multiple transverse folds in the gastric antrum

Fine transverse folds of the esophagus are well described as a transient motor phenomenon seen in patients with or without gastroesophageal reflux. They appear to be due to contraction of the muscularis mucosa and are thought to have little, if any, significance. We have observed similar transverse folds in the gastric antrum during double-contrast upper gastrointestinal series in five patients. In contrast to the transient nature of the folds in the esophagus, these gastric folds were more persistent. They were seen in multiple spot images with the gastric antrum distended or partially collapsed and even during peristalsis. In follow-up studies, the folds were repeatedly demonstrated in two patients. Two patients had associated gastric polyps with histologic evidence of chronic gastritis; however, the antral mucosa appeared normal on endoscopy. The remaining three patients had no associated gastric disease. The pathophysiologic significance of these folds is yet to be determined; however, they appear to be clinically insignificant.     

Radiographic findings of primary B-cell lymphoma of the stomach: low-grade versus high-grade malignancy in relation to the mucosa-associated lymphoid tissue concept

OBJECTIVE: We undertook this study to assess how well double-contrast radiography and CT allow radiologists to differentiate low-grade from high-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach. MATERIALS AND METHODS: We retrospectively reviewed the upper gastrointestinal radiographs and contrast-enhanced CT scans of 57 patients with pathologically proven primary gastric lymphoma (low-grade [n = 29] and high-grade [n = 28] MALT lymphoma). RESULTS: On upper gastrointestinal radiography, ulceration (39%) was the most common finding in low-grade lymphoma, whereas polypoid appearance (38%) was the most common in high-grade lymphoma. In the 29 patients (33 lesions) with low-grade MALT lymphoma, upper gastrointestinal radiography revealed 13 ulcerative lesions (39%), 10 nodular lesions (30%), four infiltrative lesions (12%), two polypoid lesions (6%), and four combined lesions (12%). In the 28 patients (29 lesions) with high-grade lymphoma, upper gastrointestinal radiography revealed 11 polypoid lesions (38%), nine infiltrative lesions (31%), six ulcerative lesions (20%), one nodular lesion (3%), and two combined lesions (7%). On CT, thickening of the gastric wall in low-grade lymphoma (range, 0.3-2.5 cm; mean, 0.8 cm) was much less than that in high-grade lymphoma (range, 0.7-8.0 cm; mean, 2.5 cm). Abdominal lymphadenopathy was less frequent in low-grade lymphoma (14%) than in high-grade lymphoma (75%). CONCLUSION: Most low-grade lymphomas show superficial spreading lesions, such as mucosal nodularity, shallow ulcer, and minimal fold thickening, on upper gastrointestinal radiography, whereas most high-grade lymphomas show mass-forming lesions or severe fold thickening.     

Delayed gastric emptying andHelicobacter pylori infection in patients with chronic renal failure

Forty patients with chronic renal failure (CRF) were enrolled in this study. Twelve of the 40 patients had upper gastrointestinal symptoms or signs (GI Sx). Twenty of the 40 patients had been receiving regular haemodialysis (HD) for at least 1 year prior to the study. Radionuclide-labelled solid meals were used to calculate gastric emptying times (GETs). The carbon-14 urea breath test (¹⁴C4-UBT) was used to diagnoseHelicobacter pylori (HP) infection. Among the 40 patients, 35 (88%) had an abnormal GET and 22 (55%) had a positive¹⁴C-UBT for HP infection. There were no statistically significant differences in the incidence of abnormal GET among patients with HP infection and patients without HP infection. There were also no significant differences in the incidence of HP infection among patients with abnormal and normal GETs. In addition, the incidences of abnormal GET in patients with and without upper GI Sx were 83% and 89% respectively. The incidences of HP infection in patients with and without upper GI Sx were 58% and 54%, respectively. The incidences of abnormal GET in HD and non-HD patients were 95% and 80%, respectively. The incidences of HP infection in HD and non-HD patients were 45% and 65%, respectively. The differences in the incidences of abnormal GET and HP infection among HD and non-HD patients, as well as among patients with and without upper GI Sx, were not statistically significant.     

HP根治前后ASCG胃肠激素及G、D、EC1细胞变化的研究

目的 :探讨HP感染的慢性活动性浅表性胃炎 (ASCG)患者HP根治前后胃粘膜中胃肠激素Gas、SS、SP和G、D、EC1细胞变化及其相关性。方法 :对 3 5例HP感染的ASCG病人 ,HP根治前后分别用放射免疫法及免疫组化染色图像定量分析检测其胃窦粘膜中Gas、SS、SP含量和G、D、EC1细胞密度、灰度。结果 :HP阳性的ASCG病人经药物治疗根除后胃粘膜Gas含量均较治疗前明显降低 (P <0 0 1或 <0 0 5 )。图像定量分析示 ,HP根治前后胃粘膜G、D、EC1细胞密度差异不显著 (P >0 0 5 )。结论 :HP感染干扰了Gas、SS激素分泌释放的调控 ,是HP相关性胃炎的发病机制之一。SP抑制胃泌素分泌释放 ,而对生长抑素无抑制作用 ,具有胃粘膜保护功能。     

幽门螺杆菌oipA基因与胃黏膜组织中IL-17表达的关系

目的探讨幽门螺杆菌(HP)oipA基因与慢性胃病及胃癌患者胃黏膜组织中IL-17表达的关系及其意义。方法收集200例慢性萎缩性胃炎(CAG)、胃溃疡(GU)及胃癌(GC)患者胃黏膜活检标本,并分为3组:HP-组,HP+(cagA+vacA+)oipA-组,HP+oipA+组。应用PCR方法检测HP+标本中oipA基因的分布情况;免疫组化SP法检测各胃黏膜组织中IL-17的表达水平,分析HP oipA基因不同状态与IL-17表达的关系。结果在HP+标本中,oipA基因阳性率为70.7%(104/147),其中CAG标本oipA检出率为56.5%(26/46),GU标本oipA基因检出率为77.6%(45/58),GC标本oipA基因检出率为76.7%(33/43)。GU及GC标本的oipA检出率高于CAG(P<0.05)。CAG、GU及GC患者中,HP-、HP+oipA-、HP+oipA+3组患者的IL-17表达均依次增高(P<0.05)。CAG患者中HP+oipA+患者IL-17的表达明显高于HP+oipA-患者(P<0.05);GU与GC患者中,HP+oipA-患者的IL-17表达均高于HP-患者,HP+oipA+患者IL-17表达均高于HP+oipA-患者(P<0.05)。oipA+的CAG、GU及GC标本中IL-17表达逐渐增高,差异有统计学意义(2χ=17.387,P<0.05)。结论 HP oipA阳性的胃黏膜IL-17表达水平高于HP oipA阴性者。     

Gastric antral vascular ectasia ("watermelon stomach"): radiologic findings

Radiologic findings in a patient with gastric antral vascular ectasia are described on computed tomographic scans, upper gastrointestinal series, and specimen radiographs. Findings include prominent, scalloped antral folds radiating to the pylorus and thickening of the gastric antrum. Pathognomonic red vascular folds, likened to stripes on a watermelon, can be seen endoscopically.     

Overlooked gastric carcinoma: pitfalls in upper gastrointestinal radiology

PURPOSE: To evaluate the reasons for misdiagnosis of gastric carcinoma at upper gastrointestinal radiography. MATERIALS AND METHODS: Upper gastrointestinal radiographs obtained within 3 years prior to diagnosis of gastric carcinoma in 336 patients were selected. Two radiologists who were initially blinded and then unblinded to the diagnosis reviewed the radiographs. Decisions were made by means of consensus. The reason for misdiagnosis was classified as perceptual error when the lesion was identified correctly at the blinded review, as possible perceptual error when the lesion was identified only at the unblinded review, and as technical error when the lesion could not be identified at either review and technical deficiencies were thought to be the cause. RESULTS: Twenty-four patients underwent upper gastrointestinal radiography within 3 years prior to diagnosis of 27 carcinomas. The reason for misdiagnosis was classified as perceptual error in 11, as possible perceptual error in four, and as technical error in five lesions. In the remaining seven lesions, the lesion could not be identified at either review, and technical deficiencies were not thought to be the cause. The most common overlooked finding was depression (10 of 15), and the most common presumed technical error was incomplete compression study (seven of 11). CONCLUSION: Careful attention should be paid to detect limited barium pooling during double-contrast studies to avoid overlooking depressions.     

Diagnosis of gastric cancers: comparison of conventional radiography and digital radiography with a 4 million-pixel charge-coupled device

PURPOSE: To evaluate the differences in accuracy and observer performance at conventional radiography and at digital radiography with a 4 million-pixel charge-coupled device (CCD) for the diagnosis of gastric cancers. MATERIALS AND METHODS: A prospective study was performed of 225 patients with suspected gastric cancer who were referred to our hospital from January 1997 through February 1997. One hundred twelve patients were examined at conventional radiography and 113 were examined at digital radiography, and 24 and 27 patients had gastric cancer, respectively. Six radiologists interpreted the images, with attention to tumor findings. They were blinded to the clinical details, and their interpretations were rated against those of three other radiologists who examined the patients and who were aware of the clinical information such as endoscopic features and/or histopathologic findings in biopsy specimens. Receiver operating characteristic (ROC) analysis was used to compare the differences in observer performance for the diagnosis of gastric cancers at conventional radiography and at digital radiography. RESULTS: The overall sensitivity was 64.6% at conventional radiography versus 75.3% at digital radiography (P =. 287); specificities were 84.5% and 90.5%, respectively (P =.011); and the positive predictive values were 53.1% and 71.3%, respectively (P =.036). ROC analysis clearly showed higher diagnostic performance at digital radiography than at conventional radiography. CONCLUSION: The data demonstrate the high diagnostic value of digital radiography with a 4 million-pixel CCD for gastric cancers. The technique has considerable potential as an alternative to conventional gastrointestinal radiography.     

High-resolution real-time compound ultrasound imaging of transient protein-losing gastropathy of childhood

We report the case of a 1.5-year-old girl with transient protein-losing gastropathy with hypertrophic gastric folds (PLGH). The diagnosis of PLGH was made by abdominal ultrasound (US) and not by an upper gastrointestinal (UGI) study as reported in many previous publications. Real-time compound ultrasound imaging showed in high detail the echogenic thickening of the mucosal gastric layer and associated hyperaemia on colour Doppler US. These ultrasonic findings highly correlated with the endoscopic US findings and microscopic changes of the gastric wall in PLGH. An awareness of the high-resolution abdominal ultrasound appearances of PLGH may facilitate earlier diagnosis and obviate the need for an upper GI contrast series.