Observations on Nine Personal Cases Where Esophagitis Has Appeared as a Complication of a Functioning Vertical Gastroplasty

This paper is based on observations on a personal series of patients who presented with severe ulcerating esophagitis, unresponsive to medical treatment following a vertical stapled gastroplasty. With one exception this was a late complication in an effective weight loss procedure. The therapeutic modalities chosen to treat this problem depended on patient choice, as well as personal experience with treating earlier cases. Unfortunately, I could find little guidance in the literature or from my colleagues on how to treat this problem. Conversion to a Roux-Y gastric bypass seemed the most satisfactory solution to the problem, relieving the symptoms and maintaining the weight loss.     

The transurethral resection syndrome

The transurethral resection syndrome ("TUR syndrome") is caused by absorption of electrolyte-free irrigating fluid, and consists of symptoms from the circulatory and nervous systems. The clinical picture is inconsistent and the syndrome is easily confused with other acute disorders. Mild forms are common and often go undiagnosed, while severe forms of the TUR syndrome are rare and potentially life-threatening. The pathophysiology is complex but includes four mechanisms: circulatory distress from the rapid absorption of electrolyte-free irrigating fluid, adverse effects of glycine, dilution of the protein and electrolyte concentrations of the body fluids, and disturbance of renal function. The treatment of the TUR syndrome consists of general life support and in specific treatment directed towards hypotension, hyponatraemia and anuria. Methods to lower the uptake of irrigating fluid are widely used and probably reduce the incidence of the TUR syndrome. However, patient safety can be guaranteed only if the absorption is monitored. An irrigating fluid containing tracer amounts of ethanol can be used for this purpose. This permits the uptake of fluid to be indicated by measuring the concentration of ethanol in the patient's exhaled breath.     

Unsere Erfahrungen mit der Infektionsprophylaxe und -therapie nach 53 Lebertransplantationen

Summary An attempt was made to reduce the risk of infection following liver transplantation by means of selective bowel decontamination with tobramycin, polymyxin E and amphotericin B, as well as short-term systemic antibiotics with cephotaxim and tobramycin. After 53 consecutive orthotopec hepatic transplants performed in 51 patients between 1985 and 1987, a total of eight pneumonias occurred as the clinically most significant infection. Two pneumonias were caused by cytomegalovirus, one by Pneumocystis carinii, one by Candida and the remaining four by various bacteria. In 6 patients, bacteria were cultured from the blood, but only in one case was an indwelling catheter identified as the source of the septicemia. Taking all samples together, Streptococcus faecalis was the bacterium most frequently cultured, which was not covered by the prophylactic antimicrobial regime applied. Pseudomonas, however, and gram-negative bacteria were demonstrated much less frequently. Vaginal and oral Candida infections, as well as oral and genital herpes simplex infections, responded well to topical therapy with fungicide and aciclovir, respectively. Three patients developed cytomegalovirus (CMV) hepatitis. All five CMV infections were successfully treated with ganciclovir and hyperimmunoglobulin, as well as reduction of prophylactic immunosuppression. Out of 15 patients transplanted for posthepatitic cirrhosis, 7 developed a recurrence of the infection (5 hepatitis B virus) 2 hepatitis C virus) in the graft. Two died of the cirrhosis, three are still alive with cirrhosis but sufficient graft function, and one patient is suffering from chronic active hepatitis. One patient grafted for acute hepatic failure was able to clear the delta virus within 1 year post-transplant. During the perioperative phase, however, we never lost a single patient to infectious complications. Therefore, bowel decontamination and antibiotic prophylaxis, including Streptococcus faecalis, are recommended.

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Unsere Erfahrungen mit der Infektionsprophylaxe und -therapie nach 53 Lebertransplantationen

Zusammenfassung Durch selektive Darmdekontamination mit Tobramycin, Polymyxin E and Amphotericin B über 8 Tage and kurzzeitige Antibiotikatherapie mit Cefotaxim und Tobramycin wurde versucht, die hohe Infektionsrate nach Lebertransplantation zu reduzieren. Nach 53 konsekutiven orthotopen Leberverpflanzungen bei 51 Patienten zwischen 1985 and 1987 traten als klinisch bedeutsamste Infekte 8 Pneumonien auf. Bei 4 Patienten waren these bakterieller Natur, 2 durch Cytomegalovirus verursacht, 1 durch Pneumocystis carnii and 1 durch Candida. 6 Patienten hatten eine Septikämie, wobei nur in 1 Fall ein Venenkatheter als Ausgangspunkt identifiziert werden konnte. Alle Proben zusammengenommen wurde am häufigsten Streptokokkus faecalis kultiviert, ein Keim, der durch das angewendete antimikrobielle Regime nicht erfaßt wird. Pseudomonaden hingegen und gramnegative Stäbchen wurden in einem wesentlich geringeren Prozentsatz nachgewiesen. Vaginale and orale Candidainfektionen erlangten ebenso wie orale and genitale Herpes simplex-Infektionen kaum Krankheitswert und wurden jeweils topisch mit einem Antimykotikum bzw. Acyclovir behandelt. Neben den 2 CMV-Pneumonien wurden auch 3 durch CMV verursachte Hepatitiden beobachtet. Alle CMV-Infekte konnten mit Gancyclovir und Hyperimmunglobulin bei gleichzeitiger Reduktion der Basisimmunosuppression beherrscht werden. Von 15 Patienten, die wegen posthepatitischer Zirrhose transplantiert wurden waren, entwickelten 7 eine Reinfektion des Transplantates (5 HBV, 2 HCV), wovon 2 an der Zirrhose verstarben, 3 mit einer Zirrhose and noch ausreichender Transplantatfunktion leben, wie auch der Patient, der eine chronisch aktive Hepatitis entwickelt hatte. Eine im akuten Leberversagen transplantierte Patientin hat das Deltavirus innerhalb eines Jahres eliminiert. In der perioperativen Phase wurde jedoch kein einziger Patient an einer infektiösen Komplikation verloren, so da auch bei fehlender Kontrollgruppe die Darmdekontamination sowie die antibiotische Kurzzeitprophylaxe empfohlen werden können.

     

Delayed transient neurologic toxicity due to tacrolimus: CT and MRI

We report a case of transient neurologic toxicity secondary to tacrolimus. The clinical and imaging findings are reported and their subsequent regression after interruption of therapy in the patient following a bone-marrow transplant is also described. The etiology of the neurotoxicity and its analogy with other immunosuppressant agents are discussed. Received: 18 June 1999/Accepted: 14 December 1999     

重度妊高征血清尿酸及β_2-MG监测对评价围产期结局的临床意义

目的 :探讨尿酸 (UA)、β2-微球蛋白(β2-MG)对重度妊高征围产期结局的影响。方法 :测定51例重度妊高征患者血清UA、β2-MG、尿素氮 (BUN)、肌酐(Cr)水平和尿蛋白定量 ,统计孕期及新生儿情况 ,按围产儿存活与否分为死亡组与存活组进行分析。结果 :(1)死亡组前3个指标明显高于存活组 ,尿蛋白定量2组差异无统计学意义。(2)血清UA水平与BUN、β2-MG水平呈正相关 ,与新生儿体重呈负相关。结论 :监测重度妊高征患者血压、尿蛋白、尿素氮、肌酐的同时更应密切监测尿酸和β2-MG的变化 ,以指导临床诊治     

Peritonsillar abscess – critical analysis of abscess tonsillectomy

The risk of secondary haemorrhage following abscess tonsillectomy is reported in the literature with differing rates. A retro‐ and prospective analysis of complication rates following abscess tonsillectomy was conducted in 142 patients (54 females, 88 males; mean age: 35 years). In 22% of patients, a secondary haemorrhage occurred. In half of these (11% of total), the haemorrhage had to be treated surgically. Secondary haemorrhage occurred most commonly on the 6th and 8th postoperative days. Reports in the literature are not in unison about the risk of secondary haemorrhage following abscess tonsillectomy and therefore allow no final judgement about an objective risk of this complication. This report strengthens the results of the ‘Comparative Audit Service’ analysis from 1997, which did show a high risk of secondary haemorrhage following tonsillectomy, as well as following abscess tonsillectomy.     

妊娠高血压综合征患者血清sICAM-1含量测定及其在妊高征发病中的作用

目的　探讨可溶性细胞间粘附分子 1(soluble intercellular adhesion molecule- 1,s ICAM- 1)在妊娠高血压综合征 (简称妊高征 )发病中的作用。　方法　应用酶联免疫吸附法 (EL ISA)测定 6 5例妊高征患者 (妊高征组 ,包括轻度 15例 ,中度 2 4例 ,重度 2 6例 )及 2 5例同期正常妊娠孕妇(对照组 )外周血清中 s ICAM- 1的含量 ;应用化学发光酶联免疫分析法测定两组孕妇血清中白细胞介素 1(interleukin- 1,L I- 1β)及肿瘤坏死因子 (tum or necrosing factor alpha,TNF- α)含量 ;并记录新生儿体重及妊娠结局。　结果　轻、中、重度妊高征组母血清中 s ICAM- 1的含量 [(36 8.5 6± 6 2 .81) μg/L、(6 0 6 .6 3± 10 5 .0 4 ) μg/ L、(85 9.36± 2 0 0 .92 ) μg/ L]均显著高于对照组 [(2 36 .6 9± 96 .33) μg/ L](P<0 .0 5 ,P<0 .0 1,P<0 .0 1) ,中、重度妊高征组母血清中 IL- 1β及 TNF- α的含量均显著高于对照组(P<0 .0 5 ,P<0 .0 1) ;中、重度妊高征组 s ICAM- 1的水平与相应 IL- 1β及 TNF- α的水平呈显著的正相关 (r=0 .6 97,P<0 .0 1;r=0 .74 6 ,P<0 .0 1)。重度妊高征组伴胎儿生长受限 (fetal growth restric-tion,FGR)者血中 s ICAM- 1含量显著高于同组其他孕妇之含量 (P<0 .0 5 )。妊高征组     

妊高征患者脂蛋白酯酶基因变异(Ser447-Thr)的研究

目的　研究妊高征患者体内脂蛋白酯酶 (LPL)的一个基因变异 (Ser4 4 7-Thr)的发生率 ,探讨该基因改变与妊高征发病的关系。方法　测定 5 4例重度妊高征患者与 4 8例健康孕妇对照组的血脂水平 ,并提取其外周血白细胞中的DNA ,通过PCR扩增LPL第 9外显子 ,利用限制性内切酶片段长度多态法及DNA测序分析结果。结果　重度妊高征组的TG、VLDL和Apo -Ⅱ水平明显高于对照组 ,重度妊高征组和对照组的Ser4 4 7-Thr等位基因变异频率 (分别为 9 2 6 %和 5 2 1 % )无显著差异 (χ2 =1 2 2 ,P >0 0 5 )。结论　LPL第 9外显子的Ser4 4 7-Thr等位基因变异可能只是一种基因多态性 ,而与妊高征的发生无关联     

质子泵抑制剂预防化疗所引起胃炎的随机对照临床研究

为了探讨质子泵抑制剂预防及抑制化疗所引起的化学性胃炎的有效性 ,随机对照研究了不同治疗方法 ,预防基于多柔比星、氮烯咪胺、铂类、伊立替康和 5 -氟尿嘧啶所组成的化疗方案所致的胃炎的疗效 ,研究组采用质子泵抑制剂、安定和 5 HT3 受体拮抗剂预防胃炎和呕吐方法 ,对照组使用常规传统的地塞米松加 5 HT3 受体拮抗剂 ,进行跟踪观察、疗效比较 ,并从不良反应、耐受性及安全性等方面加以分析比较。研究组胃炎发生率 0 ( 0 /11) ,对照组为 72 .73 % ( 8/11) ,P =0 0 0 1;化疗后完全无上消化道症状 /体征者 ,研究组 75 0 0 % ( 3 3 /4 4) ,对照组 5 2 2 8% ( 2 4/4 6) ,P =0 0 2 5 ;化疗后 7d无症状 /体征者 ,研究组 10 0 % ( 4 4/4 4) ,对照组 76 0 9% ( 3 5 /4 6) ,P =0 0 0 1。初步研究结果提示 ,质子泵抑制剂对化疗过程中所引起的化学性胃炎有明显的预防及抑制作用 ,而且有效率高、不良反应小、安全性好 ,患者有良好的耐受性。     

妊娠晚期人类小DNA病毒B19感染情况,母婴传播及与早产或小于胎龄儿关系的研究

为了解妊娠晚期人类小ＤＮＡ病毒Ｂ１９（ＨＰＶＢ１９）感染情况、母婴传播及与早产或小于胎龄儿的关系，将１０４例母亲及其新生儿分成两组，试验组包括１９例早产儿、３２例小于胎龄儿及其母亲；对照组包括５３例正常新生儿及其母亲。采用聚合酶链反应技术（ＰＣＲ）检测母血、脐血和胎盘组织ＨＰＶＢ１９ＤＮＡ；用鼠抗Ｂ１９单克隆抗体和Ｂ１９联合抗原（ＶＰ１＋ＶＰ２）建立了捕获式ＥＬＩＳＡ法检测母血和脐血ＨＰＶＢ１９特异性ＩｇＭ抗体。结果：１０４例母血中，ＨＰＶＢ１９ＩｇＭ阳性２例（１．９％），１０４例脐血中阳性３例（２．９％）。在母血、脐血及胎盘组织各１０４例中检出ＨＰＶＢ１９ＤＮＡ阳性分别为６例、４例、６例。因此试验组５１对母婴共１０２例中６例有ＨＰＶＢ１９感染（５．９％）；对照组５３对母婴共１０６例中２例有ＨＰＶＢ１９感染（１．９％）。两组Ｂ１９感染率差异无显著意义。提示：在北京地区，妊娠晚期存在Ｂ１９急性感染，应引起重视；Ｂ１９感染与早产或小于胎龄儿的发生可能不相关；新生儿Ｂ１９感染是通过胎盘传播的。对有Ｂ１９感染证据的新生儿进行随访及研究如何阻止胎盘传播很重要。