The stapled, uncut gastroplasty for hiatal hernia: 24 years'' follow-up

A simple, tension-free, in situ gastroplasty was devised in the late 1960s and early 1970s to avoid the recurrences and complications of the Collis and Nissen hiatal hernioplasties. Long-term follow-up has now been completed on 153 patients. For this procedure, the anterior gastric wall is stapled, not cut, and the fundoplication is performed on the cardia and the neoesophagus created by the stapling and is sutured under the diaphragm. A total of 161 patients underwent the stapled, uncut gastroplasty and were followed for up to 24 years. Conditions included reflux in 145, organic stricture in 23, giant hiatal hernia in 14 (with or without obstruction) and collagen esophagus in six. Post-operative tests included subjective symptom evaluation by questionnaire, esophageal manometry and 24-h pH monitoring. Of the total 161 patients, 89 were followed up for 2-10 years and 64 for 1-24 years; seven were lost to follow-up and one died soon after the operation. The stapled, uncut gastroplasty and fundoplication produced 95% excellent and good results (Matthews classification grade I and II). After the procedure, the esophagus was significantly lengthened (from 2.55 +/- 0.96 to 3.2 +/- 0.32 cm; p < 0.001) and sphincter pressure was significantly increased (from 6.35 +/- 3.5 to 27.3 +/- 6.82 mmHg; p < 0.0001). No leakage, bleeding, or 'slipped' recurrence was observed. Only one patient experienced dissolution of the wrap and recurrent symptoms. Aspiration, scleroderma, stricture and short esophagi, post-gastrectomy gastric remnants and hiccups were treated with excellent and good long-term results. The stapled, uncut gastroplasty has universal application with excellent results, not only in typical cases of gastroesophageal reflux, but also in complicated situations such as short esophagus, strictures, or dysperistaltic and aperistaltic esophagus.     

MR imaging of the scrotum: normal anatomy

High-resolution magnetic resonance (MR) imaging with a surface coil was utilized to evaluate the normal scrotum. Scrotal contents, spermatic canal, and inguinal regions were visualized within the same field of view. Differences in signal intensity in the testis, epididymis, tunica albuginea, fluid, fat, and spermatic cord allowed for clear delineation of these structures in detail. The high contrast and spatial resolution of MR imaging, coupled with the wide field of view and absence of ionizing radiation, make MR imaging well suited for evaluation of the scrotum.     

Colonic stenoses: use of oral barium when retrograde flow is completely obstructed on barium enema studies

Forty patients with complete obstruction to retrograde barium flow on barium enema examinations, without clinical or radiographic evidence of obstruction, were studied further with orally administered barium in the same session. All patients had undergone aborted double-contrast barium enema studies and had received antispasmodics intramuscularly before the examination. The authors describe the technique, as well as the clinical and radiologic findings, that allows the safe ingestion of oral barium in patients with stenotic lesions of the colon. In all patients, oral barium passed through the small bowel and the stenotic site in an average of 148 minutes, with no complications. In seven patients, there were synchronous lesions in the colon and small bowel, and the findings were determined better with oral barium studies in 19 patients. If a barium enema study is done and retrograde passage of barium is obstructed by a lesion in the left side of the colon, additional diagnostic information can be obtained by giving the patients oral barium. This practice is safe if precise criteria are applied.     

N-(6,6-二甲基-2-庚烯-4-炔基)-N-甲基-α-取代-1-(4-取代)萘甲胺类的合成及抗真菌活性

根据氮唑类和烯丙胺类抗真菌化合物的构效关系、作用机理。设计合成了30个N-(6,6-二甲基-2-庚烯-4-炔基)-N-甲基-α-取代-1-(4-取代)萘甲胺类化合物。初步体外抑菌试验结果表明,大多数目标化合物对八种试验菌株都有不同程度的抗真菌活性。化合物Ⅰ_1a的真菌活性大致与克霉唑相当,对白念珠菌的活性明显高于naftifine和terbinafine,但对其它七种菌株的活性均不及naftifine和terbinafine;化合物Ⅲ_1a对八种试验菌株的活性均与terbinafine相当。