食管静脉曲张破裂出血内镜下介入治疗

目的总结３６４例肝炎后肝硬化合并食管静脉曲张破裂出血患者进行内镜下介入疗法的经验。方法内镜下采用５％鱼肝油酸钠（ＳＭ）或１％乙氧硬化醇（ＡＳ）进行食管静脉曲张硬化治疗（ＥＶＳ），六连发圈套器结扎治疗（ＥＶＬ）和医ＭＴＨ胶或凝血酶食管静脉内栓塞治疗（ＥＶＥ）。结果三种介入方法平均急诊止血率为８９．９％；食管静脉消失率为７７．２％。结论内镜下介入疗法是控制食管静脉曲张出血，消除食管静脉曲张的有效方法，操作较容易，再出血率较低；ＥＶＬ可替代ＥＶＳ作为食管静脉曲张破裂出血首选方法。ＥＶＥ法有异位栓塞之虑，目前暂不宜广泛开展。     

经颈静脉肝内门体支架分流术的并发症及其防治

目的探讨经颈静脉肝内门体支架分流术（ｔｒａｎｓｊｕｇｕｌａｒｉｎｔｒａｈｅｐａｔｉｃｐｏｒｔｏｓｙｓｔｅｍｉｃｓｔｅｎｔ－ｓｈｕｎｔ，ＴＩＰＳＳ）的并发症及其防治。方法分析３１例行ＴＩＰＳＳ术患者的情况。结果手术成功率９６７％，术后近期并发症有转氨酶升高（１００％）、术后炎性反应（３２２％）、胆道出血（６４％）、术后死亡（６４％）、腹膜炎（３２％）。术后远期并发症有胆红素升高（５４８％）、白蛋白下降（２９０％）、支架狭窄或阻塞（１９３％）、低蛋白水肿（１６１％）、肝性脑病（１６１％）、合并肝癌（６４％）。结论ＴＩＰＳＳ术应严格掌握适应证并应严密注意术后并发症的防治。     

AEROMONAS SOBRIA INFECTION WITH SEVERE MUSCLE DEGENERATION IN A PATIENT WITH ALCOHOLIC LIVER CIRRHOSIS

A 56-yr-old male who had been followed for alcoholic liver disease was admitted for abdominal pain and a high fever. Gastrointestinal endoscopy revealed bleeding esophageal varices that were treated by endoscopic sclerotherapy. Blood culture on admission was positive for Aeromonas sobria . Then skin bullas and ulcers and severe muscle degeneration developed. The patient died despite extensive treatment with antibiotics. A. sobria infection in patients with liver cirrhosis is rare.     

肝硬化食管静脉曲张患者食管动力学变化与血清一氧化氮的关系

目的 探讨肝硬化食管静脉曲张患者食管动力学变化与血清一氧化氮(NO)的关系。方法 用核素及Griess法分别检测肝硬化食管静脉曲张患者的食管通过时间,胃食管返流与血清(NO)水平。结果 肝硬化食管静脉曲张患者食管通过时间延长,胃食管返流发生率及血清NO量增高。结论 肝硬化食管静脉曲张患者食管动力学变化与血清NO水平呈正相关。     

USE OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT AS A BRIDGE TO TRANSPLANTATION IN FULMINANT HEPATIC FAILURE DUE TO BUDD CHURI SYNDROME

We report a case of fulminant hepatic failure in a 55-yr-old man due to Budd-Chiari syndrome in the setting of polycythemia rubra vera. The patient presented with acute hepatic failure, which rapidly progressed to grade IV hepatic encephalopathy. Placement of a transjugular intrahepatic portosystemic shunt resulted in marked improvement of the encephalopathy and stabilized the liver failure. Suhsequently, he underwent successful nonemergent orthotopic liver transplantation. Transjugular intrahepatic portosystemic shunt placement is a safe, effective, therapeutic option to bridge patients with fulminant Budd-Chiari to liver transplantation.     

切脾加分流术治疗血吸虫病门脉高压症远期随访

目的：观察脾切除术附分门体分流术治疗血吸虫病肝纤维化门脉高压症的远期效果。方法：术后每年由基层血防专业人员随防记录,每隔5－10年由外科医师检查,重点记录存活率、死亡原因及有关并发症。结果：所有病例分别随访5－10、11－20、21－30、31－40年,生存率分别为73．7％、61．5％、49．2％、32．8％,比较各分流术式结果,以脾腔分流为佳。结论：血吸虫病肝纤维化如有食道静脉曲张出血倾向者,手术治疗以脾切除附加脾腔端侧分流术为首选。     

ESOPHAGEAL VARICEAL BLEEDING CAUSED BY HYPOPLASIA OF THE PORTAL VEIN IN A PATIENT WITH THE KLIPPEL-TRENAUNAY SYNDROME

The case of a patient affected by Klippel-Trenaunay syndrome presenting with esophageal variceal bleeding caused by hypoplasia of the vena porta is reported. Hemostasis was achieved by performing a proximal spleno-renal shunt. We discuss the likely association of this mesodermal development abnormality and vascular disorders of the portal vein.     

LIFE-THREATENING HEMORRHAGE IN A PATIENT WITH GASTRIC CANCER AND ACQUIRED HEMOPHILIA

We report a case of a patient with life-threatening hemorrhage caused by the presence of acquired factor VIII inhibitors after gastrectomy for signet-ring cell carcinoma of the stomach. Acquired factor VIII inhibitors should be taken into consideration as a cause of acquired bleeding tendency among patients with gastrointestinal malignancies especially when the coagulation tests are unusual.     

CLINICAL APPLICATION OF AN INDWELLING NEEDLE FOR ESOPHAGEAL VARICES IN ENDOSCOPIC INJECTION SCLEROTHERAPY WITH SIMULTANEOUS LIGATION

Endoscopic injection sclerotherapy (EIS), in which a sclerosing agent is infused into esophageal varices, is advantageous in obstructing a blood‐supplying route; however, accurate intravascular infusion is technically difficult. To achieve accurate continuous intravascular infusion that does not depend on respiration or vomiting reflex, we developed an indwelling needle for esophageal varices. This indwelling needle facilitated intravascular puncture, as demonstrated for conventional puncture needles, and stabilized infusion of a sclerosing agent. Furthermore, EIS with ligation (EISL) prevented hemorrhage after the needle was removed. EISL with an indwelling needle may improve the treatment results.     

食管静脉曲张密集结扎术和硬化及结扎联合术的疗效对照观察

比较内镜下食管静脉曲张密集结扎术和内镜下硬化及结扎联合术治疗食管静脉曲张破裂出血的疗效。４２例食管静脉曲张破裂出血病情稳定的病人分为两组，２２例患者接受ＤＥＶＬ，２０例病人行ＥＳ＋ＥＶＬ，两组具有可比性（Ｐ＞０．０５）。第１次治疗，ＤＥＶＬ组每个病人平均结扎１１．３２个点，每根曲张静脉平均结扎２．８３个点；ＥＳ＋ＥＶＬ组首先静脉内注射硬化剂，然后行结扎，第１次治疗平均每根曲张静脉注射硬化剂１．０３次（点），结扎１．０１个点。结果：第１次治疗后，ＤＥＶＬ组食管静脉曲张消失率为５０％，ＥＳ＋ＥＶＬ组为３５％，两组比较无统计学意义（Ｐ＞０．０５）；第１、４、１２及２４周的再出血率，ＤＥＶＬ组为４．５％、４．５％、４．５％、４．５％，ＥＳ＋ＥＶＬ组为１０％、１５％、１５％、２５％，两组无显著差别（Ｐ＞０．０５）。ＤＥＶＬ和ＥＳ＋ＥＶＬ均为治疗食管静脉曲张破裂出血、根除食管静脉曲张的有效方法，ＤＥＶＬ的操作较容易、并发症较少、再出血率较低，内镜下食管静脉曲张密集结扎术将取代内镜下硬化剂注射疗法，成为治疗食管静脉曲张破裂出血的首选方法。     

ENDOSCOPIC ULTRASONOGRAPHY FINDINGS AND CLINICAL BACKGROUNDS IN CASES WITH EARLY RECURRENCE OF ESOPHAGEAL VARICES AFTER ENDOSCOPIC INJECTION SCLEROTHERAPY

Aims: To investigate the factors affecting early recurrence of esophageal varices after endoscopic injection sclerotherapy (EIS). Subjects and Methods: Forty‐four cases with esophageal varices were examined by esophagogastroscopy and endoscopic ultrasonography (EUS) 2 months after EIS. Cases with and without red color (RC) signs evaluated within 1 year after EIS were classified as Early Recurrent Group (ERG) and Non‐Early Recurrent Group (N‐ERG), respectively, and compared with EUS images and clinical backgrounds. Results: Compared with ERG (17 cases), N‐ERG (27 cases) had significantly higher detection rates of cardiac intramural veins (CV) and esophageal intramural veins (EV), larger maximum diameters of CV and EV, and higher numbers of CV (P < 0.05). The detection rates of gastric perforating veins (GPV)—but not esophageal perforating veins (EPV), paragastric veins (PGV), or paraesophageal veins (PEV)—correlated with recurrence of varices (P < 0.05). ERG differed in age, gender, γ‐glutamyltranspeptidase (GTP), and detection rates of portosystemic (PS) shunts from N‐ERG (P < 0.05). Age, serum alanine aminotransferase (ALT) and γ‐GTP level, detection rates of PS shunt, maximum diameters of CV and EV, numbers of CV, and GPV‐positive case differed (P < 0.10) by univariate analysis, and maximum diameters (hazard ratio (HR)), 7.16: 95% CI [1.45–35.33]; P = 0.016) and numbers (HR, 1.96: 95% CI, [1.02–3.75]; P = 0.043) of CV differed significantly between the two groups by multivariate analysis. Conclusions: EUS is useful in predicting recurrence of esophageal varices after EIS, and the degree of the development of CV is the most important critical factor for early recurrences.     

THE INFLAMMATORY RESPONSE IN THE SYNOVIUM OF A PATIENT WITH ROSS RIVER ARBOVIRUS INFECTION

Ross River virus has been incriminated in the etiology of many sporadic and epidemic cases of polyarthritis in Australia and the Pacific. Both synovium and synovial exudate fluid recovered from the knee of an epidemic polyarthritis patient showed a predominantly mononuclear leucocyte infiltrate. Infectious virus could not be recovered from the synovial exudate. Functional natural killer cells were detected in the synovial fluid. Their level of cytotoxic activity was similar to that detected in the peripheral circulation. (Aust NZ J Med 1985; 15: 336–339.)     

PNEUMOCYSTIS CARINII PNEUMONIA IN A PATIENT WITH RHEUMATOID ARTHRITIS, NOT ON IMMUNOSUPPRESSIVE THERAPY AND IN THE ABSENCE OF HUMAN IMMUNODEFICIENCY VIRUS INFECTION

We report a case of Pneumocystis carinii pneumonia in a patientwith rheumatoid arthritis, not on immunosuppressive therapy,and in the absence of human immunodeficiency virus infection;investigation revealed a CD4+ T-lymphopenia. KEY WORDS: Pneumocystis carinii, Rheumatoid arthritis, Lymphopenia     

IMMUNOLOGICAL RECONSTITUTION IN A PATIENT WITH SEVERE COMBINED IMMUNE DEFICIENCY USING NON-SIBLING BONE MARROW DEPLETED OF T CELLS WITH HuLy-m1

Abstract An infant with severe immune deficiency received bone marrow from an HLA-A, -B, -DR matched, mixed leucocyte reaction non-reactive first cousin. The donor marrow was fractionated on a discontinuous Percoll gradient and before infusion was treated with the anti-human T lymphocyte antibody, HuLy-m1, and rabbit serum as a source of complement. Methotrexate was given during the following two weeks. A rise in the peripheral blood lymphocyte count, indicating engraftment, occurred six weeks after transplantation. There was no clinical evidence of graft versus host disease (GVHD). Engraftment has been sustained for one year and the patient is in normal health and has normal in vitro immunological function. In vitro treatment of human marrow with HuL-m1 allows stable engraftment and may be useful in attempting to diminish or prevent GVHD.