Helicobacter pylori in Peptic Ulcer: Have Koch's Postulates Been Fulfilled?

This brief review considers whether or not Koch's postulates have been fulfilled for Helicobacter pylori and peptic ulceration. The histological features of peptic ulcer disease in man are active chronic gastritis with antral predominance, duodenal gastric metaplasia and active duodenitis. Other features are hyperpepsinogenaemia, relative postprandial hypergastrinaemia and basal acid hypersecretion. The macroscopic features are duodenal bulb ulceration or lesser curve and antral gastric ulceration.

At present, gastric colonization with H. pylori has been produced in small animal species (rats and mice), but the infection is difficult to establish in immunocompetent animals, and histological gastritis is unconvincing. In larger animals the germ-free pig has been the most reliable model but the gastritis tends to be chronic with little activity.

The best examples of acute infection are in three ‘self-administration’ experiments in humans. In these cases acute gastritis with hypochlorhydria developed which, when it converted to active chronic gastritis, tended to be asymptomatic. Either the circumstances were incompatible with ulceration, or the experiments were not continued for the many years necessary to develop peptic ulceration. It is concluded that only one of the many steps required for the development of peptic ulceration has so far been fulfilled, i.e. the ability of H. pylori to produce histological gastritis in a susceptible host.     

消化性溃疡患者的骨密度变化

目的　为探讨消化性溃疡（溃疡病）对患者骨密度（ＢＭＤ）的影响。方法本文采用双能Ｘ 线骨密度仪（ＤＥＸＡ）测定了１１４ 例溃疡病患者腰椎及右股骨上端（Ｎｅｃｋ、Ｗ ａｒｄ 三角、Ｔｒｏｃｈ）的骨密度。结果　从疾病、性别、年龄、体重指数（ＢＭＩ）等方面将溃疡病患者ＢＭＤ 的变化与相匹配的正常对照组ＢＭＤ 进行分析比较,发现溃疡病患者ＢＭＤ 广泛低于对照组,以腰椎改变具有显著差异（Ｐ＜０．０１）。结论　溃疡病患者存在明显骨丢失,其骨质疏松症（ＯＰ）患病率为男３１．０３％ 、女４２．８６％ 。     

A new method of evaluating the degree of stenosis using a multisensor catheter

Summary A new method of evaluating the degree of stenosis using the pressure loss coefficient is presented here. The pressure loss coefficient was obtained in patients with pulmonary or aortic stenosis by measuring the pressure and velocity of the blood simultaneously with a multisensor catheter. Although the pressure gradient across the stenosis was augmented by increasing the blood velocity with pharmacological loading, the pressure loss coefficient remained nearly constant. This confirmed that the pressure loss coefficient is more appropriate for evaluating the degree of stenosis than the pressure gradient, which depends on the blood velocity.The pressure loss coefficients obtained from the preoperative and postoperative catheterization data were compared to evaluate the effects of the surgical operation. A pressure loss coefficient of 15 was proposed as the critical value for the indication of operation.     

扩大壁细胞迷走神经切断术治疗十二指肠溃疡并发症150例的远期效果

目的探讨扩大壁细胞迷走神经切断术（ＥＰＣＶ）的远期临床效果。方法自１９７９年始应用ＥＰＣＶ治疗十二指肠溃疡并发穿孔、出血和狭窄１５０例,其中穿孔１０３例,出血１２例,狭窄３５例。结果全组１３１例获得随访,总的溃疡复发率为２．３％,复发狭窄率为２．９％,再出血率为０。ＶｉｓｉｃｋⅠ级为８３．２％,Ⅱ级为１０．６％,Ⅲ级为３．１％,Ⅳ级为３．１％;Ⅰ级和Ⅱ级共占９３．８％。结论作者认为ＥＰＣＶ术后远期患者无论是消化吸收功能和营养状态,还是恢复劳动能力和生活质量都较高,进一步证实该手术设计的合理性和可行性     

强压力波对血管内皮细胞、血管平滑肌细胞释放内皮素、一氧化氮的影响

目的探讨强压力波对血管内皮细胞及血管平滑肌细胞释放内皮素（ＥＴ）、一氧化氮（ＮＯ）的影响。方法１５只犬高速投射物致伤，检测致伤前后血浆ＥＴ、ＮＯ浓度，并用肠系膜血管内皮细胞（ＶＥＣ）、血管平滑肌细胞（ＶＳＭＣ）联合培养，体外检测强压力波致伤前后培养上清中的的ＥＴ－１、ＮＯ浓度。结果高速投射物致伤犬后血浆中的ＥＴ、ＮＯ浓度显著升高。联合培养血管内皮细胞、平滑肌细胞致伤后ＥＴ、ＮＯ浓度在致伤后１０分钟迅速升高，至６小时仍维持在较高水平，且以ＥＴ升高更显著，持续时间更长。结论实验结果提示在血管应激反应过程中，血管组织可能通过局部自分泌、旁分泌方式，释放ＥＴ－１、ＮＯ调节局部血管舒缩功能。在高速投射物致伤的强压力波作用下，由于ＥＴ释放占优势，在血管出现以收缩为主的反应中可能起重要作用     

MEBT治疗慢性顽固性皮肤溃疡168例

慢性皮肤顽固性溃疡，是由多种原因引起的一种常见病。临床治疗极为棘手，尤其是一些营养不良性溃疡和长期不愈合的溃疡，多无自行愈合的倾向，还有可能发生癌性变。笔者根据“烧伤是一切创疡的总和”之原理，利用MEBT治疗慢性顽固性溃疡168例，均得到满意疗效。认为其方法独特可靠，安全方便，疗效显著，值得推广。     

高速枪弹伤时内皮细胞内皮素释放及mRNA转录的变化

目的：探讨高速枪弹伤时产生的强压力波对血管内皮细胞内皮素（ＥＴ－１）的释放及基因表达的影响。方法：以高速枪弹致伤犬腹部以及高速枪弹压力波致伤培养人脐静脉内皮细胞为实验模型，采用放射免疫及斑点杂交的方法，从整体、细胞、基因不同层次观察内皮细胞ＥＴ－１释放及表达的特点。结果：致伤犬和培养的内皮细胞在压力波作用下，ＥＴ－１释放和基因表达的变化具有相似的趋势，出现即刻和延迟反应，即伤后１０分钟至６小时ＥＴ－１释放明显增加，ｍＲＮＡ（ＥＴ－１）转录增强则出现在伤后４～６小时。结论：压力波是导致ＥＴ－１释放及基因表达紊乱的重要力学因素，ＥＴ－１ｍＲＮＡ转录增强可能是压力波对ＥＴ－１调节的延迟效应的分子病理学基础。     

次侧切术治疗期肛裂前后肛门直肠压力对比分析

目的 :探讨次侧切开内括约肌治疗肛裂术前、术后肛门直肌压力的变化。方法 :采用自行设计的次侧方内括约肌切开加双缘结扎术治疗 期肛裂 6 0例 ,测定手术前后肛门直肠压力 ,并与 6 0例正常人肛压比较 ,评价新术式治疗 期肛裂的临床疗效及其对肛门功能的影响。结果 :显示术后患者肛管静息压显著降低 ,与术前比较有显著性差异 (P <0 .0 1) ,与正常人比较无显著性差异 (P>0 .0 5 ) ;肛管最大收缩压与术前及正常人比较无显著性差异 (P>0 .0 5 )。结论 :次侧方内括约肌切开加双缘结扎术能有效地解除内括约肌痉挛 ,从根本上消除高肛压 ,从而彻底治愈肛裂 ,而且不影响肛门功能。