活血清胰汤灌肠辅助手术治疗对急性重症胰腺炎患者的疗效观察

目的：探讨活血清胰汤灌肠辅助手术治疗急性重症胰腺炎对患者AMS、UAMY、LPS水平及免疫功能的影响。方法：选取2019年3月至2020年3月陕西省宝鸡市中医医院收治的急性重症胰腺炎患者70例作为研究对象,按随机数字表法将其分为对照组和观察组,每组35例。2组均采用经内镜逆行性胰胆管造影术进行治疗,对照组术后给予常规治疗,观察组术后在对照组的基础上加用活血清胰汤灌肠治疗,2组均治疗1周。比较2组治疗1周后的临床疗效;比较2组治疗前、治疗1周后的胰腺炎标志物水平、细胞免疫指标及体液免疫指标水平。结果：治疗1周后,观察组总有效率为94.29%,高于对照组（77.14%,P<0.05）。与治疗前比较,治疗1周后,2组血清AMS、LPS、UAMY及CD8+水平均降低,且观察组低于对照组（P<0.05）;2组血清CD3+、CD4+、IgG、IgM、IgA水平及CD4+/CD8+比值均升高,且观察组高于对照组（P<0.05）。结论：活血清胰汤灌肠辅助手术治疗急性重症胰腺炎,可通过降低患者血清AMS、LPS及UAMY水平,缓解炎性反应,同时可改善免疫功能,进而有助于提高疗效。     

清胰通腑汤治疗重症急性胰腺炎疗效观察

目的 观察清胰通腑汤对急性胰腺炎的临床疗效.方法 将78例急性胰腺炎随机分为治疗组(40例)和对照组(38例),对照组给予禁饮食、持续胃肠减压、广谱抗生素、维持水/电解质及酸碱平衡、奥曲肽等治疗:治疗组在对照组基础上加用清胰通腑汤,每次150 mL鼻饲管内灌入,每日2～3次.结果 治疗组的首次排大便时间、腹胀痛消失时间、血尿淀粉酶恢复正常时间、白细胞恢复正常时间、住院时间明显短于对照组.结论 清胰通腑汤结合常规西医治疗急性胰腺炎的疗效较佳.     

麦粒灸治疗脾虚泄泻证的临床研究

目的：观察麦粒灸对脾虚泄泻证患者唾液淀粉酶活性、尿D－木糖、血清SIgA的影响。方法：将112例患者随机分为治疗组（56例）和对照组（56例）。治疗组采用麦粒灸患者脾俞、胃俞、足三里穴,每穴3壮,隔日1次,连续30天,对照组接受中药治疗。结果：麦粒灸能显著改善患者脾虚泄泻症状,并显著提高唾液淀粉酶活性,尿D－木糖排泄率及降低血清SIgA,其作用优于对照组,结论：麦粒久脾虚泄泻疗效肯定。     

急性有机磷农药中毒患者血液淀粉酶和血糖的变化及临床意义

为探讨急性有机磷农药中毒患者血液淀粉酶（ＡＭＳ）活性和血糖浓度的变化及临床意义。血液ＡＭＳ活性检测采用磺－－淀粉比色法;血糖检测采用葡萄糖氧化酶电极法。急性有机磷农药中毒患者血液ＡＭＳ活性和血糖浓度,均显示高于健康对照组（Ｐ〈０．０１）;中、重度中毒患者显著高于轻度中毒患者（Ｐ〈０．０１）。急性有机磷农药中毒患者血液ＡＭＳ活性和血糖浓度明显升高,且与中毒程度相关。     

Respiratory symptoms and sensitization in bread and cake bakers

This purpose of this study was to examine the relationship betweenexposure to wheat flour, soya flour and fungal amylase and thedevelopment of work-related symptoms and sensitization in breadand cake bakery employees who have regular exposure to thesesubstances. The study populations consisted of 394 bread bakeryworkers and 77 cake bakery workers whose normal jobs involvedthe sieving, weighing and mixing of ingredients. The groupswere interviewed with the aim of identifying the prevalence,nature and pattern of any work-related respiratory symptoms.They were also skin-prick tested against the common bakery sensitizingagents, i.e., wheat flour, soya flour, rice flour and fungalamylase. The results of personal sampling for sieving, weighingand mixing operations at the bakeries from which the study groupswere taken were collated in order to determine typical exposuresto total inhalable dust from the ingredients, expressed as 8hour time-weighted average exposures. Data from the health surveillanceand collated dust measurements were compared with the aim ofestablishing an exposure-response relationship for sensitization.The prevalence of work-related symptoms in bread bakery andcake bakery ingredient handlers was 20.4% and 10.4% respectively.However, in a large proportion of those reporting symptoms inconnection with work, the symptoms were intermittent and ofshort duration. It is considered that the aetiology of suchsymptoms is likely to be due to a non-specific irritant effectof high total dust levels, rather than allergy. None of thecake bakers and only 3.1% of the bread bakers had symptoms whichwere thought to be due to allergy to baking ingredients. Usingskin-prick testing as a marker of sensitization, the prevalenceof positive tests to wheat flour was 6% for the bread bakersand 3% for the cake bakers. Comparable prevalences for soyaflour were 7% and 1 % respectively. However, the prevalenceof positive skin-prick tests to fungal amylase was 16% amongstthe bread baking group with only a single employee (1 %) inthe cake baking group having a positive test. Furthermore, thisemployee had previously worked in a bread bakery. The differencein rates of sensitization to wheat flour between the bread andcake bakers is not statistically significant, whereas the differencefor soya flour is at the borderline of statistical significance(p=0.045). In contrast, the difference in fungal amylase sensitizationis significant at the 0.1% level. For both bread and cake bakers,the 8 hour time-weighted average exposures for each of the activitiesshowed a wide variation with mixing having the lowest averageexposure and sieving the highest. Out of the allergens studiedin this investigation, fungal amylase is the principal sensitizerin large scale bread bakeries, with the main source of exposurebeing the handling of bread improvers. In contrast, the riskof sensitization to wheat flour is low in both bread and cakebakeries. The absence of positive skin-prick tests in the subgroupof cake bakery employees who regularly handle fungal-amylase-containingflour suggests that their levels of exposure are below the thresholdfor sensitization to amylase.     

Lipase/amylase ratio distinguishes mild acute biliary pancreatitis from nonpancreatitis

The report by Gumaste et al. [Gastroenterology 1991;101:1361–1366] that the lipase/amylase ratio (Lip/Amy) could be a new index distinguishing acute episodes of alcoholic (Lip/Amy >2) from nonalcoholic pancreatitis (Lip/Amy <2), with the critical value being Lip/Amy =2, has been followed by some debate between supporters and opponents. By comparing the Lip/Amy in a group of 16 carefully selected patients with mild acute gallstone-related (biliary) pancreatitis with that in a reference group of 44 controls, this study examines whether or not this ratio could be a useful index for diagnosing biliary pancreatitis. Considering that both pancreatic and hepatobiliary systems are blocked by stones, hepatic biochemical parameters such as serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin (TB) were also included in fitting the regression equation. The average value of Lip/Amy in the biliary pancreatitis group was 2.29 ± 0.93, while that in the control group was 1.30 ± 0.99. Thus, Lip/Amy was found to be a significant index for distinguishing mild acute biliary pancreatitis from nonpancreatitis. However, the critical value of Lip/Amy seemed to depend on the diet pattern and cultural background.     

重症急性胰腺炎合并胰性脑病30例分析

目的 探讨重症急性胰腺炎合并胰性脑病的临床特点、出现时间与血尿淀粉酶、脑脊液、脑电图以及颅脑CT变化的关系.方法 根据1992年亚特兰大国际胰腺病会议制定"急性重症胰腺炎"的定义和中华消化学会胰腺病学组2003年上海会议制定的"急性胰腺炎诊治指南"作为诊断标准,并排除Wernicke脑病后进行回顾分析.结果 30例胰性脑病中,合并消化道出血16例,胸腹水14例,ARDS 3例,感染性休克2例,低钙血症10例,胰周脓肿2例,中毒性心肌炎9例,并发症发生率占86.3%;始发病因以胆源性疾患居多,出现精神神经症状的中位时间为8 d;PE组72 h BA、PEBA水平和各种并发症的发生率与对照组差异有显著性(P＜0.05).结论 胰性脑病发病高峰期多为病发后1周内,常与其他并发症并存;病人症状为反应迟钝、定向力障碍、意识模糊、幻觉及昏迷等;但脑脊液、脑电图及颅脑CT均正常;血中淀粉酶增高是PE发生的关键环节,其它并发症是促发因素;及时采用药物控制PLA2的释放及胰腺实质的广泛坏死,对于提高重症急性胰腺炎的抢救成功率,减轻胰性脑病发生,降低死亡率很有意义.     

Cytodiagnosis of submandibular sialadenitis with crystalloids mimicking metastasis

Sialomrgaly of suhmandibultir gland, whether inflammatory or neoplastic can be clinically mistaken for lymphoid metastasis especially when encountered in an elderly patient. Other than the neoptastic lesions and usual inflammatory lesions rarely amylase crystalloids can evoke a granulomatous response and can result in sialomegaly. We report an interesting case which presented as a submandibular swelling and was clinically diagnosed as metastasis where the diagnosis of granulomatous response to crystalloids was made at FNAC. The aim of this report is to bring an awareness of the existence of such lesions and to highlight the role of FNAC in diagnosis of such lesions in order to avoid unnecessary surgeries.     

Ultrastructural,immunohistochemical and biochemical studies on amylase and ACTH producing lung cancer

Summary Tumour tissue from a lung cancer patient who showed elevated serum amylase and adrenocorticotropin (ACTH) was studied ultrastructurally, immunohistochemically and biochemically. Histologically the tumour was a small cell carcinoma. On electron microscopic examination the tumour cells contained large zymogen-like granules within the cytoplasm. Furthermore, cells which possessed many small dense core granules of the endocrine type were also observed. It was of interest that the large zymogen-like granule-containing tumour cells had microvilli at the apical border, connected by desmosomes and forming lumina showing adenocarcinomatous differentiation. Electrophoretic analysis of the serum revealed that the major elevated amylase was of the salivary type with minor components. Immunostaining clearly demonstrated that most of the tumour cells possessed immunoreactive ACTH, whereas salivary amylase was only found in occasional clusters of the tumour cells. The results seem to indicate that the tumour showed both endocrine and exocrine characteristics - an amphicrine carcinoma, expressing amylase and ACTH simultaneously.