Häufigkeit pathologischer Veränderungen des oberen Gastrointestinaltraktes bei Patienten vor Herzoperationen

Resümee Schwerwiegende gastroduodenale Erkrankungen sind bei fast der Hälfte aller Patienten, die sich einer Operation am offenen Herzen unterziehen müssen, auch bei Fehlen von Symptomen nachweisbar. Das erhebliche Überwiegen von Magenläsionen spricht dafür, daß die arteriosklerotisch bedingte Perfusionsminderung der Schleimhaut die entscheidende Ursache hierfür ist. Routinemäßige präoperative Ösophago-Gastro-Duodenoskopien können die nicht unerhebliche durch gastrointestinale Komplikationen bedingte postoperative Mortalität senken helfen.

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Pathological changes in the upper gastrointestinal tract in patients awaiting open heart surgery

Summary While waiting for open heart surgery, in 153 patients (104 male, 49 female, 22–76 years of age) without gastrointestinal symptoms and/or history esophago-gastro-duodenoscopy was performed. 124 patients suffered from coronary heart disease, 29 from valvular defect, aneurysm of the sinus of Valsalva or tumor of the heart.In 47.1% endoscopy revealed serious abnormal findings: in 16.3% gastric ulcer, in 20.9% erosive gastritis, duodenal ulcer and erosive duodenitis in 5.2%, respectively, 1 case of gastric carcinoma, 2 of large polyps and 3 of reflux esophagitis of higher degree (totally 3.9%).In patients with coronary artery disease, the relation of erosive and ulcerous gastric lesions as compared with those of duodenal origin was 41, in patients with other cardiac diseases it was 21, respectively (p<0,001).Compared with a normal population, the incidence of pathological gastric findings was 54-fold higher in our patients, and 1.7-fold concerning duodenal lesions, respectively (p<0.001).51 patients on acethylsalicylic acid (160 mg/ die) showed pathologic findings in 41.2%, and 96 patients without ulcer-inducing therapy in 51%. Thus, low-dose Aspirin does not seem to have serious gastric side effects.The results of the study stress the necessity of routinely performed endoscopy of the upper gastrointestinal tract in patients awaiting open heart surgery. This will lead to a lower incidence of serious gastrointestinal complications postoperatively, which are known to have a high mortality.

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Abkürzungen ASS Azetylsalizylsäure - J. Jahre - GI-Trakt Gastrointestinaltrakt     

足底板对类风湿性关节炎患者足底压的影响

目的 :测定类风湿性关节炎病人足底压 ,评价足底板的生物力学效应。方法 :12名女性类风湿性关节炎病人和 8名健康女性进行年龄和体重匹配。用 F- Scan系统进行动态足底压测量 ,Kistler床反力平台用以校正测量精确性。测量足底峰压和垂直分力 ,评价足底板的生物力学表现。结果 :类风湿性关节炎病人中足底压明显高于健康人。使用足底板后 ,足底总的峰压明显降低 ,前足、后足峰压减低 ,中足峰压增高。而垂直分力改变不大。结论 :足底板能显著降低足底压力 ,使足底压力重分布 ,减轻类风湿足痛。特殊设计的足底板对类风湿足痛的治疗能起重要的作用     

足背皮神经的显微断层解剖及其临床意义

目的 为不同部位断足再植提供理论基础和有关数据。方法 用体视学方法对６６例成人足背皮神经进行了观测。结果 腓深神经的平均横径和面积分别为：第１断层３．０５ｍｍ,３．２８ｍｍ＾２;腓浅神经的平均横径和面积分别为：第１断层３．１４ｍｍ,２．３８ｍｍ＾２;足背内侧皮神经的平均横径和面积分别为：第１断层２．７５ｍｍ,２．１４ｍｍ＾２,第５断层２．６８ｍｍ,２．０９ｍｍ＾２;足背中间皮神经的平均横径和面积分     

豚鼠应激性胃溃疡模型的制作与验证的实验研究

该实验首次应用豚鼠水浸拘束法制作应激性胃溃疡的模型,从胃溃疡指数、应激前后胃电活动的变化、胃粘膜病理改变等方面观察应激性胃溃疡的发生、发展过程。该实验模型易制作,重复性好,适合应用于应激性胃溃疡的实验研究。     

Accuracy of a rapid 10-minute carbon-14 urea breath test for the diagnosis of Helicobacter pylori-associated peptic ulcer disease

Urease in the human gastric mucosa is a marker for infection with Helicobacter pylori (HP), an organism which is associated with peptic ulcer disease. To detect gastric urease, we examined 184 patients (144 males, 40 females; mean age: 49.8±15.6 years) with suspected peptic ulcer disease. Fasting patients were given orally 5 Ci of carbon-14 labelled urea. From each patient only one breath sample was collected in hyamine at 10 min. The amount of ¹⁴C collected at 10 min was expressed as follows: [(DPM/mmol CO₂ collected)/(DPM administered)] × 100 × body weight (kg). The presence of HP colonization was determined by examination of multiple endoscopic prepyloric antral biopsy specimens subjected to culture or a rapid urease test. For the purpose of this study, HP-positive patients were defined as those with characteristic bacteria as indicated by a positive result of either the culture or the rapid urease test; HP-negative patients were defined as those with negative findings on both the culture and the rapid urease test. Of the 184 cases, 99 (53.8%) were positive for HP infection, and 85 (46.2%), negative. The sensitivity and specificity of the rapid 10 min ¹⁴C-urea breath test for the diagnosis of HP-associated peptic ulcer disease were evaluated by a receiver operating characteristic (ROC) curve with a variable cut-off value from 1.5 to 4.5. When a cut-off value of 1.5 was selected, the sensitivity was 100% and the specificity, 83.5%; when a cut-off value of 4.5 was selected, the sensitivity was 54.5% and the specificity, 97.6%. Correspondence to: Chia-Hung Kao     

Rectal Mucosa Damage in Rabbits After Subchronical Application of Suppository Bases

The effect of suppository bases on rabbit rectal mucosa was investigated using six triglyceride bases, polyethylene glycol, and a triglyceride base combined with monoglycerides or fatty acids and methyl esters of those acids. Rectal irritation was evaluated and scored according to defined pathological features. Pure triglycerides and a triglyceride to which a nonionic surfactant was added caused severe mucosal damage with ulceration and inflammation. Hyperemia was characteristic for irritation by polyethylene glycol suppositories. Mucosal damage by a pure triglyceride combined with monoglycerides or fatty acids and methyl esters of those acids was similar but statistically less pronounced than with all other bases.     

Ergebnisse der selektiv proximalen vagotomie nach 13 Jahren

Zusammenfassung Es wird über die Langzeitergebnisse von 216 Patienten berichtet, bei denen zwischen 1970 und 1978 wegen eines Ulcus duodeni eine selektiv proximale Vagotomie (SPV) vorgenommen wurde. Die mittlere Nachbeobachtungszeit beträgt 12,8 Jahre (8,3–15). 26 Patienten erlitten ein symptomatisches Ulkusrezidiv (12%)4–135 Monate postoperativ, die kumulative Rezidivrate beträgt 20,3 % nach 13 Jahren (Kaplan-Meier). Säuresekretionsmessungen ergaben eine mittlere Reduktion der basalen (BAO) und mittleren stimulierten Sekretionswerte (MAO) von 80,7 bzw. 74,8 % ohne Unterschiede zwischen Patienten mit und ohne Rezidiv. Das Rezidivrisiko war für Ulcus duodeni (22 von 194) und pylorische Geschwüre (4 von 22) vergleichbar, ebenso fanden sich keine Unterschiede bezüglich dem Geschlecht, einer zusätzlichen Drainage-Operation, dem Rauchverhalten, akuter oder elektiver Operation und erstem oder Rezidivgeschwür. Nach der Operation komplizierter Ulzera war das Rezidivrisiko tendentiell höher (p 0,07). 78,5% der Patienten erreichten ein (sehr) gutes funktionelles Langzeitergebnis (Visick I oder II), nur 6% mußten als Visick III eingestuft werden. Die SPV kann daher als ein ungeachtet der Patienten-Compliance wirksames und wertvolles Therapieverfahren zur Behandlung des Ulcus duodeni erachtet werden.

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Results of highly selective vagotomy after 13 years

Summary This study reports the long-term results of 216 patients after highly selective vagotomy (HSV) for duodenal ulcers operated from 1970 through 1978 with a mean follow-up of 12.8 years (8.3–15). 26 patients developed symptomatic ulcer recurrences (12%) within 4 to 135 months following surgery, the cumulative recurrence rate (Kaplan-Meier) at 13 years was 20.3%. Acidity analyses showed a postoperative mean reduction of basal acid output (BAO) and maximal acid output (MAO) values of 80.7 % and 74.8 % respectively with no differences according to recurrences. The risk of recurrence was similar for duodenal (22/194) and pyloric ulcers (4/22) and no differences were found with respect to sex, additional drainage procedure, smoking habits, acute or elective operation and first or recurrent ulcers. Risk was slightly higher for complicated ulcers (p 0.07), but without reaching statistical significance. 78.5% of patients showed (very) good results (Visick I or II), only 6% were Visick III. HSV is therefore regarded as a valuable therapeutic measure for the treatment of duodenal ulcer independent of patient compliance.

     

原发性胃绒毛膜癌临床病理分析

研究胃原发性绒毛膜癌的组织学特点，探讨其组织学的发生。方法：对１例残胃原发性绒毛膜癌进行尸检、组织学观察，应用免疫组织化学研究其组织学的发生。结果：肿瘤表现单一的绒毛膜癌形态伴有坏死和出血，肿瘤转移至肝脏，双肺及胃周围淋巴结。免疫组化肿瘤表达ＨＣＧ阳性，部分肿瘤细胞表达ＣＫ阳性。在目前英文文献报道的４８例胃原发性绒毛膜癌中，２８．３％病例以单一的绒毛膜癌形态，１３％的病例胃为腺癌而转移灶为绒毛膜癌     

蚕蚀性角膜溃疡的综合治疗

目的:探讨蚕蚀性角膜溃疡的最佳有效治疗方案。方法:将连续治疗的蚕蚀性角膜溃疡患者54例(77眼),按治疗方案的不同分为3组,单纯角膜溃疡切除联合板层角膜移植组21眼,角膜溃疡及邻近球结膜切除联合板层角膜移植组19眼,板层角膜移植术后联合应用地塞米松、环孢霉素A组37眼,对其疗效进行回顾性分析。结果:单纯角膜溃疡切除联合板层角膜移植术组一次性手术治愈率为48%,复发率为33%。角膜溃疡联合临近球结膜切除板层角膜移植术组一次性手术治愈率为68%,复发率为26%。板层角膜移植联合应用免疫抑制剂组一次性治愈率为76%,复发率为24%。结论:角膜溃疡及邻近球结膜切除联合板层角膜移植术后应用地塞米松及环孢霉素A眼液是目前治疗蚕蚀性角膜溃疡的最佳有效方法。     

Molecular epidemiology of enterovirus 71 infection in the Western Pacific Region

BACKGROUND: Recently, there have been large outbreaks of hand, foot and mouth disease (HFMD) mainly caused by enterovirus 71 (EV71) associated with severe neurological diseases in the Western Pacific Region (WPR). To monitor the realtime trend of EV71 transmission throughout the WPR, the authors conducted a molecular epidemiological analysis of EV71 infection. METHODS: Viruses were isolated from clinical samples from patients with HFMD or those with neurological complications. The EV71 isolates were identified by microneutralization assay. The VP4 and/or VP1 regions of recent EV71 isolates were sequenced and subjected to phylogenetic analysis using reference EV71 strains. RESULTS: The phylogenetic analysis of EV71 isolates from the WPR revealed two major genogroups, B and C, based on the nucleotide sequence alignment of the VP1 or VP4 region. These two major genogroups were further divided into subgenogroups, B1, B2, B3, and B4 and C1, C2, C3 and C4, respectively. CONCLUSIONS: The molecular epidemiological analyses of recent and previous EV71 isolates in the WPR indicated that two major genogroups of EV71 are co-circulating in Australia, Malaysia, Singapore, Taiwan and Japan. Recent EV71 isolates in Mainland China constitute a new distinct genetic cluster, subgenogroup C4. Two major lineages of EV71 are the major causative agents of the present HFMD epidemics in the WPR and both are considered to be neurovirulent.