黄芪建中汤治疗十二指肠球部溃疡临床总结

十二指肠球部溃疡属于中医胃脘痛的范畴。按中医辨证分型适于黄芪建中汤治疗的有３种类型,即脾胃虚寒型、脾胃虚弱型、气虚血瘀型。通过用黄芪建中汤加减治疗４５例十二指肠球部溃疡病患者,其中临床治愈１４例,占３１．１％;好转者２７例,占６０％;无效４例,占８．９％。总有效率为９１．１％。     

复发性口腔溃疡患者血Cu、Fe、Zn含量分析

目的探讨微量元素在复发性口腔溃疡发病中的作用。方法检测了43例复发性口腔溃疡患血清微量元素Cu、Fe、Zn含量，并与正常健康人相比。数据经方差分析，求P值经t检验。结果复发性口腔溃疡患血清Cu、Zn含量明显低于对照组，而Fe含量高于对照组。结论提示缺Zn是诱发复发性口腔溃疡的因素之一。     

Funktionelle Anatomie der Magenstrombahn Lokalisierende Faktoren in der Pathogenese des Magengeschwürs

Zusammenfassung Vergleichend-anatomische Daten zeigen, daß Säuresekretion und intragastrale Druckerhöhungen typischerweise in räumlich getrennten Organen stattfinden. Im einhöhligen Magen des Menschen laufen diese Vorgänge zeitlich getrennt ab. Finden beide Prozesse zur gleichen Zeit in einem Hohlorgan statt, kann es zu diskreten Durchblutungsstörungen kommen. Experimentell wurde das zugrundeliegende submucöse Steal-Phänomen am Hund mit Hilfe der Mikrosphärenmethode nachgewiesen. Eine Analyse der Magenstrombahn des Menschen zeigt, daß dieses Grenzlinienphänomen zu diskreten Kreislaufstörungen an den Prädilektionsorten des Magengeschwürs führt.

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Functional anatomy of the gastric vascular bed: Localizing factors in the pathogenesis of human gastric ulcer

Summary Comparative vertebrate anatomy shows that acid secretion and wall stress processes typically occur in different compartments. In the human single-chamber stomach both processes are physiologically separated in time. If both processes take place in one hollow organ at the same time, focal ischemia will occur. Using the microsphere technique a submucous stealphenomenon, which the effect is due to, has been reproduced experimentally. A network model of the human gastric vascular bed produces borderline infarcts at the preferred sites of human gastric ulcer.

     

280例老年人纤维胃镜检查分析

本文对280例老年人纤维胃镜检查结果进行分析。重点论述慢性胃炎,胃癌,胃溃疡等镜下所见及老年人胃镜检查的意义。     

Fatal pancreatitis secondary to iatrogenic intramural duodenal hematoma: A case report and review of the literature

Intramural duodenal hematoma (IDH) is a rare finding in the adult, especially when related to iatrogenic complications of ulcer treatment. It can lead to biliary obstruction and pancreatitis, which proved fatal in our case. Contrastenhanced computed tomography (CT) is invaluable in detecting the abnormality and can definitely be diagnostic.     

Bone Histomorphology May Be Unremarkable in Diabetes Mellitus

Abstract Background and Purpose:  Histomorphological studies on bone in human diabetes mellitus are scarce. The aim of this study was to observe the histomorphological appearance of bone in amputation specimens from feet of patients with diabetes mellitus. Material and Methods:  Routine histopathology reports on 45 amputation specimens were evaluated, provided the osteotomy was located in unaffected bone tissue. The bone morphology of regions affected with gangrene and/or osteomyelitis was considered, as well as the morphology at the dissection margin at a distance from the affected parts. The specimens were obtained from 43 diabetic patients, most of whom exhibiting the so-called neuroischemic diabetic foot with infection. The patients' age ranged from 50 to 92 years, duration of diabetes from 0 to 52 years; polyneuropathy was present in 36, peripheral ischemic vessel disease (PIVD) in 30, and renal failure in 24 of them, respectively. Results:  There were 22 clinical cases of osteomyelitis, 20 cases of gangrene (including three cases of necrosis without surrounding inflammation), and three cases of pressure ulcer, which were treated by amputation of 24 toes, and resection of 21 metatarsal bones, respectively. Histomorphology showed osteomyelitis (n = 29), bone necrosis (n = 1), myelofibrosis (n = 8), and normal bone (n = 7) at the affected sites, compared to normal bone (n = 26), myelofibrosis (n = 12), and osteoporosis (n = 7) at the osteotomy sites. In cases of clinical gangrene, bones were also affected by osteomyelitis, but less so than in cases of clinical osteomyelitis (8/18 vs. 22/22; p < 0.001). Bone tissue at the osteotomy sites was normal – with some myelofibrosis – in both conditions. Conclusion:  This pilot study shows that histomorphology of unaffected foot bone is mostly not abnormal in diabetic patients with neuropathy and PIVD. Further study is necessary to corroborate this preliminary evidence of absence of a “diabetic osteopathy” in the diabetic foot.      

胫骨横向骨搬移结合负压引流治疗糖尿病足溃疡的临床疗效分析

目的 :探讨胫骨横向骨搬移微血管网再生技术结合封闭负压引流治疗伴溃疡形成的糖尿病足的临床疗效。方法:对2015年11月至2016年12月采用胫骨横向骨搬移结合负压引流治疗的19例伴溃疡形成的糖尿病足的临床资料进行回顾性分析,男15例,女4例;年龄42~82岁,平均(64.57±7.14)岁;糖尿病平均病程(14.62±6.19)年;左足12例,右足7例;溃疡面积2 cm×3 cm~8 cm×6 cm;按照Texas分类法进行分类,所有病例为D期,其中2级3例,3级10例,4级6例。手术前后测量踝肱指数及密歇根神经体征评分(MNSI)评价患足周围血管和周围神经功能恢复情况,术后复查血管造影或血管彩超。结果:19例患者中17例术后获得随访,时间3~13个月,平均6.9个月。17例患足创面均得到愈合;术后3个月踝肱指数由术前的0.51±0.20升至0.93±0.18,差异有统计学意义(t=13.63,P=0.000);术后3个月的MNSI为5.76±1.44,优于术前的4.06±1.36,差异有统计学意义(t=7.31,P=0.000)。术后复查血管造影或血管彩超显示患足微血管网再生满意,患足功能达到正常运动和日常生活需要。结论:胫骨横向骨搬移微血管网再生技术可以重建患肢小腿以下微血管网,促进周围血管及周围神经恢复,结合封闭负压引流可促进创面愈合,具有手术简便、疗效确切,保肢成功率高的优点,是治疗糖尿病足溃疡的理想方法之一。     

国产法莫替丁治疗胃、十二指肠溃疡病双盲多中心的临床研究

为评价国产法英替丁(Famotidine,FT)治疗消化性溃疡的疗效和安全性,在北京和上海15所医院进行了一项多中心研究。FT的剂量为40mg/日;对照组雷尼替丁(Ramitidine,RT)为300mg/日,共完成十二指肠溃疡的疗效观察480例,胃溃疡123例,分为FT胶囊组,片剂组和RT组。经胃镜判断疗效,结果显示:FT治疗胃溃疡六周的愈合率,不论胶囊组(79％)或片剂组(86.7％)均明显高于RT组(61.3％,P<0.05)。十二指肠溃疡四周的愈合率,胶囊组为66.7％,片剂组为67.5％,与RT组(70.8％)比较无显著差别,本药无严重副作用,仅少数病人有轻度口干、便秘、头晕、失眠,与对照组相似,也未发现对肝、肾功能有毒性反应。     

主动脉粥样硬化性溃疡的16层CT诊断

目的：探讨应用16层螺旋CT诊断主动脉粥样硬化性溃疡的价值。方法：分析15例经16层螺旋CT诊断为主动脉粥样硬化性溃疡，14例以急性主动脉综合征就诊，1例以慢性病史就诊。观察溃疡的大小、形态、深度、数量及周围结构关系等。结果：单发溃疡12例，多发溃疡3例；14例急性患者均伴发范围较广泛的主动脉壁内血肿，其中10例合并中量以上血性胸腔、纵隔及心包积液，而1例慢性患者仅为局限的假性动脉瘤，不合并壁内血肿及血性积液等。结论：16层螺旋CT能够对主动脉粥样硬化性溃疡作出准确诊断，可作为急诊首选检查方法。