Study of controlling acute hemorrhage from esophageal varices rupture with technique of traditional Chinese medicine

Ｔｗｏｆａｃｔｏｒｓａｒｅｒｅｐｏｒｔｅｄｔｈａｔｔｈｅｍｏｖｉｎｇｖｅｌｏｃｉｔｙｏｆｆｏｏｄｂｏｌｕｓｐａｓｓｉｎｇｔｈｒｏｕｇｈｅｓｏｐｈａ ｇｕｓｉｓｉｎｆｌｕｅｎｃｅｄｂｙｓｏｍｅｆａｃｔｏｒｓ（2）．Ａｎｄｓｏｍｅｄｒｕｇｓｈａｖｅｂｅｅｎｐｒｏｖｅｄｔｏｂｅｅｆｆｅｃｔｉｖｅｉｎｃｏｎ ｔｒｏｌｌｉｎｇｇａｓｔｒｉｃｂｌｅｅｄｉｎｇ（3,4）．Ｂａｓｅｄｏｎｔｈｅｓｅｔｗｏｆａｃｔｏｒｓ,ｗｅｄｉｓｃｏｖｅｒｅｄｓｉｎｃｅ 1993ｔｈｅＣｈｉ ｎｅｓｅｄｒｕｇｓｔｈａｔｃｏｕｌｄａｄｈｅｒ…     

半侧面肌痉挛的诊断和治疗

目的　观察半侧面肌痉挛患者的临床表现和肉毒毒素对半侧面肌痉挛的治疗效果。方法　对近 3年来神经内科门诊诊断的面肌痉挛病人 2 90例进行回顾性研究 ,使用 Cohen's量表对治疗效果进行评估。结果　治疗后起效时间是 5 .4± 7.8天 ,效果持续 18.4± 6 .1周。治疗后完全缓解率达 83.8% ,明显缓解率达 15 .2 %。 30 %的患者有副作用 ,主要是面肌、眼睑无力 ,眼睑下垂 ,流泪和眼干及复视 ,但这是暂时的、可逆的 ,2周内基本消失。结论　 A型肉毒毒素治疗方法简便、易行 ,是治疗面肌痉挛的首选药物     

一氧化氮对犬下食管括约肌压力的作用

目的 :应用苄基二甲基十四烷氯化铵 (benzyldim ethyltetradecyl amm onium chloride,BAC)建立犬下食管括约肌(L ES)无神经动物模型 ,研究一氧化氮 (NO)对 L ES压力的作用。方法 :将 BAC环周注入犬 L ES,对照组注入等量生理盐水 ,均于注射前及注射后 6周测定 L ES压力 ;并观察 L -精氨酸、D -精氨酸、硝普钠及一氧化氮合酶 (NOS)抑制剂 N-硝基 - L -精氨酸 (L - NNA)对 L ES压力的影响 ;此外还测定了两组犬 L ES中 NO含量和 NOS活性。结果 :BAC处理组 L ES压力 [(4 2 .43±4.19) m m Hg,1m m Hg=0 .133 k Pa]显著高于对照组 [(2 2 .71± 5 .19) mm Hg]。 L -精氨酸可使对照组 L ES压力降低 ;L - NNA使其增高 ,但对 BAC处理组 L ES压力均无影响。硝普钠可降低两组犬 L ES压力。对照组 L ES中 NO为 (6 .0 5 8± 2 .0 6 7)μm ol/g,NOS为 (1.45 8± 0 .146 ) U /mg;而 BAC处理组 NO为 (1.797± 0 .873)μmol/g,NOS为 (0 .46 3± 0 .0 39) U /m g,均较对照组显著降低 (P<0 .0 1)。 结论 :BAC可使犬 L ES压力增高 ,其机制可能与 L ES局部 NO减少有关。     

机械吻合与手工吻合在食管外科中并发症的对比分析

目的　评价机械吻合在食管外科中的应用价值。方法　选择我院 1984～ 1994年间行食管癌、贲门癌切除术病例 ,比较机械吻合和手工吻合组术后与吻合技术相关的并发症的发生率。结果　机械吻合组平均手术时间、术后平均住院日均较手工组缩短 ;吻合口瘘、吻合口出血及死亡率 ,机械吻合组分别为 3.3%、0 .7%和 3% ;手工吻合组分别为 7.2 %、1.3%和 4.6 % ;轻、中、重度吻合口狭窄 ,机械吻合组分别为 2 .3%、2 .6 %和 0 .9% ,手工吻合组分别为 3%、4.5 %和 1.5 %。结论　机械吻合能有效降低术后并发症发生率 ,临床效果优于手工吻合。     

Comparison of Billroth I,Billroth II,and Roux-en-Y reconstructions following distal gastrectomy: A systematic review and network meta-analysis

Major surgical treatment for distal gastric cancer include Billroth I (BI), Billroth II (BII), and Roux-en-Y (RY). Since the optimal reconstruction methods remains inconclusive, we aimed to compare these treatments in terms of intraoperative and postoperative course after distal gastrectomy with a systematic review and random-effects network meta-analysis. We searched PubMed, Web of Knowledge, Ovid's database for prospective, randomized, controlled trials comparing the outcomes of BI, BII, and RY reconstruction after distal gastrectomy until January 2020. From the included studies, operative time, intraoperative blood loss, postoperative hospital stay, endoscopic findings and complications were extracted as the short- and long-term outcomes of reconstructions. The network meta-analysis was performed with R 3.5.2 software as well as “gemtc” and “forestplot” packages. Twelve randomized controlled trials (RCTs) involving 1662 patients were included. RY reconstruction has a lower risk and degree of remnant gastritis than BI and BII reconstructions(OR 0.40, 95%Crl: 0.24–0.64; OR 0.36, 95% Crl: 0.16–0.83, respectively). BI reconstruction method took significantly less time to perform as compared to BII and RY reconstruction (WMD 20, 95% Crl: 0.18–41; WMD 30, 95% Crl: 14–25, respectively). No differences in intraoperative blood loss, time to resumed oral intake, postoperative hospital stay, reflux oesophagitis and complications among the three reconstructions. The RY reconstruction after distal gastrectomy was more effective in preventing remnant gastritis than Billroth I and Billroth II reconstruction, although RY reconstruction was considered as technical complexity.     

Cast immobilization in bayonet position versus reduction and pin fixation of overriding distal metaphyseal radius fractures in children under ten years of age: a case control study

PurposeCompletely displaced distal radius fractures in children have been traditionally reduced and immobilized with a cast or pin fixed. Cast immobilization leaving the fracture displaced in the bayonet position has been recently suggested as a non-invasive and effective treatment alternative. This is a pilot comparative study between reduction and no reduction.MethodsWe assessed subjective, functional and radiographic outcome after a minimum 2.5-year follow-up in 12 children under ten years of age who had sustained a completely displaced metaphyseal radius fracture, which had been immobilized leaving the fracture in an overriding position (shortening 3 mm to 9 mm). A total of 12 age-matched patients, whose similar fractures were reduced and pin fixed, were chosen for controls. ResultsAt follow-up none of the 24 patients had visible forearm deformity and the maximal angulation in radiographs was 5° Forearm and wrist movement was restored (< 10° of discrepancy) in all 24 patients. Grip strength ratio was normal in all but three surgically treated patients. All patients had returned to their previous activities. One operatively treated boy who was re-operated on reported of pain (visual analogue scale 2).ConclusionThe results of this study do not demonstrate the superiority of reduction and pin fixation over cast immobilization in the bayonet position of closed overriding distal metaphyseal radius fractures in children under ten years with normal neurovascular findings.Level of evidenceIII