Combined laparoscopic and endoscopic treatment of perforated gastroduodenal ulcer using the ligamentum teres hepatis (LTH)

We propose a novel technique for laparoscopic treatment of perforated gastroduodenal ulcers. The principle of this procedure involves the closure of the perforated ulcer using the ligamentum teres hepatis (LTH). The LTH is cut near its umbilical end and then dissected up to the site of its hepatic insertion. The umbilical extremity of LTH is grasped with a Dormia noose passed through the ulcerated perforation via a gastroscope. Using the noose, the LTH is pulled through the ulcerated perforation until its volume fits and completely closes the perforation. This laparoscopic technique was performed in 15 patients (12 M, 3 F) with anterior perforated duodenal ulcer revealed within the previous 6 h. The procedure could not be performed in three cases: diameter of the perforation exceeding 1.5 cm (n=1), general purulent peritonitis (n=2). In the other 12 cases, closure of the ulcerated perforation with the LTH was realized without technical difficulty. The postoperative course was uncomplicated. The posttreatment comfort was excellent; the mean period of hospitalization was 10 days (range, 8–14 days). An endoscopic examination carried out following 5 weeks of anti-H2 treatment showed that cicatrization of the ulcer was good and that no pyloric stenosis remained. These initial results suggest that laparoscopic treatment of perforated gastroduodenal ulcer using the LTH is a simple procedure which can be performed with general assurance of success in patients whose perforated ulcers have occurred quite recently. As the laparoscopic procedure is less aggressive than a laparotomy, it enhances the postoperative comfort of patients and prevents the risk of parietal complications. Compared to laparoscopic endosuture this procedure is simple, effective, easier, and particularly adapted to large ulcerated perforation or when an ulcer's edges are tough or friable, tending to tear when knots are tied.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Nashville, TN, USA, 18–19 April 1994.     

康复新液联合奥美拉唑对HP阴性胃溃疡的疗效分析

目的分析康复新液联合奥美拉唑治疗幽门螺杆菌(HP)阴性胃溃疡患者的疗效。 方法选取HP阴性胃溃疡患者108例,随机均分为对照组和联合组。对照组接受奥美拉唑针剂治疗,联合组接受康复新液联合奥美拉唑针剂治疗。比较两组临床疗效、血清胃蛋白酶原(PG)、高迁移率族蛋白B1(HMGB1)、细胞炎症因子水平及不良反应发生率。 结果联合组治疗总有效率高于对照组(P＜0.05)。与治疗前比较,两组治疗后PGⅠ、PGⅡ、HMGB1、白细胞介素-6、肿瘤坏死因子-α及C反应蛋白均有降低,且联合组较对照组降低更明显(P＜0.05)。两组患者治疗期间总不良反应发生率比较,差异无统计学意义(P＞0.05)。 结论康复新液联合奥美拉唑针剂可提高HP阴性胃溃疡患者的临床疗效,值得临床应用推广。     

翼状胬肉切除术后并发角膜溃疡的危险因素分析

目的 探讨翼状胬肉切除术后并发角膜溃疡的危险因素。方法 选取2017年5月—2022年3月在青岛市中医医院行翼状胬肉切除术的患者153例,统计术后角膜溃疡发生情况,将并发角膜溃疡的患者作为发生组,其余作为未发生组。比较两组患者一般资料,采用多因素Logistic逐步回归模型分析翼状胬肉切除术后并发角膜溃疡的危险因素。结果 153例行翼状胬肉切除术的患者,术后30例并发角膜溃疡作为发生组,其余123例作为未发生组。与未发生组比较,发生组糖尿病、复发性翼状胬肉、手术操作不规范、角膜缝线松动及激素类药物应用不合理的构成比升高（P <0.05）。多因素Logistic逐步回归分析结果显示,糖尿病[OR=2.678(95%CI:2.013,3.343)]、复发性胬肉[OR=2.280(95%CI:1.659,2.900)]、手术操作不规范[OR=7.036(95%CI:4.152,9.919)]、角膜缝线松动[OR=3.466(95%CI:2.632,4.300)]及激素类药物应用不合理[OR=5.217(95%CI:3.021,7.414)]均是翼状胬肉切除术后并发角膜溃疡的危险因素（P...     

Ultrastructure of another spiral organism associated with human gastritis

Summary Campylobacter pylori may not be the only organism that causes active chronic gastritis in man. We report two cases of gastric infection with a spiral organism distinct fromC. pylori. The first patient is a 36-year-old female who presented with epigastric pain and abdominal colic present since childhood and who had 14 cats. Endoscopy was normal. The second patient kept two dogs. Histology of gastric mucosal biopsy specimens in both patients revealed active chronic gastritis, most severe in body mucosa. Giemsa stain revealed bacteria with four to eight spirals, 0.5 m in diameter and 3–7 m in length. The organisms had multiple sheathed flagella at the pole and smooth cell walls without axial filaments. The organisms resembled the gastric spirillum that has been seen in cats, dogs, and nonhuman primates. After antibacterial therapy with bismuth subsalicylate, amoxicillin, and metronidazole, the organisms disappeared in both patients and the gastritis healed.UnlikeC. pylori, this new spirillum prefers to colonize gastric mucosa containing parietal cells. Whereas this type of organism is a common commensal in other mammals, it appears to be associated with and a possible cause of gastritis in humans.     

消化道癌症患者血浆纤维连接蛋白的变化及其与微血管的关系

分析27例消化道癌症患者(其中胃癌18例,食道癌与结肠癌9例)和6例胃溃疡病人的血浆纤维连接蛋白(Fn)的变化。结果发现三者间无明显差异(P>0.05),但胃癌病人中有转移病灶者(n=7)及伴胃炎者(n=10)与相应对照组比,血浆Fn有非常明显降低(p<0.01)。胃癌组织中Fn免疫荧光主要集中在胃癌病人胃壁组织多形核白细胞浸润的炎症区及微血管周围,癌变区Fn免疫荧光很弱,甚至消失。对上述变化的意义进行了讨论。     

大鼠保留交感神经的高选择性迷走神经切断术实验模型的建立

目的：建立保留交感神经的高选择性迷走神经切断术（ＨＳＶ－ＡＰ）的动物实验模型。方法：６０只雄性ＳＤ大鼠随机分为三组：ＨＳＶ－ＡＰ组、ＨＳＶ组和正常对照组（Ｃ组），每组２０只。结果：ＨＳＶ－ＡＰ术后胃壁泌酸区交感神经分布密度与Ｃ组比较，下降不显著，去甲肾上腺素含量与Ｃ组无差别（７４５．０±４０８．９ＶＳ８９９．６±２３５．１，Ｐ＞０．０５）。而ＨＳＶ术后胃部泌酸区交感神经分布密度显著下降，去甲肾上腺素含量低于ＨＳＶ－ＡＰ术后（２９３．０±２１４．８ＶＳ７４５．８±４０８．９，Ｐ＜０．０１）。ＨＳＶ－ＡＰ术后胃体部迷走神经追踪脑干内未见标记细胞，而胃窦部迷走神经追踪脑干内可见标记细胞。结论：本试验证实采用保留胃小弯血管的ＨＳＶ—ＨＳＶ－ＡＰ术式，既可完整切断支配胃部泌酸区的迷走神经，又可保留交感神经。     

组胺H_2受体阻断剂对大鼠失血性应激反应时胃功能和溃疡指数的影响

用反射光谱法,研究了组胺H_2受体阻断剂Famotidine对急性失血大鼠胃粘膜血液量及血氧饱和度的影响。同时观察了胃液量和酸排出量的变化,并计量了溃疡指数。Famotidine(3mg/kg及8mg/kg,iv)对失血前大鼠胃粘膜血液量和血氧饱和度均未见有影响;对失血后胃粘膜血液量和血氧饱和度的降低有明显保护作用,对胃液量和酸排出量均有显著抑制作用,溃疡指数减小。     

16例应激性溃疡的临床诊治体会

目的 报告应激性溃疡的临床诊治体会。方法 全组16例,男12例,女4例。术前均无溃疡病史,血红蛋白检查均正常。术后早期应用糖皮质激素9例,出血前发生肺不张、严重呼吸道感染、呼吸功能不全6例,低血容量休克5例,急性重症出血坏死性胰腺炎4例,食管癌、贲门癌术后6例,严重烧伤(80％(?)Ⅱ°)1例。14例保守治疗,2例保守治疗无效而手术治疗。结果14例经治疗后(2例手术治疗)痊愈出院,2例死亡。结论 应激性溃疡大出血患者多病情危重,难以忍受二次手术,死亡率约为50％,因此应采取有效的保守治疗,对于保守治疗无效、大出血休克或胃肠穿孔者应及时手术治疗。     

Mdm2、Bc1-2、AR在良性脑膜瘤中表达的关系

目的研究凋亡相关蛋白mdm2、bcl-2和AR（雄激素受体）之间的关系，为脑膜瘤的性激素对抗治疗提供一些新信息。方法从华西医院病理科获得04年1月-07年12月病理诊断明确的脑膜瘤共394例，计算机随机抽样60例，其中良性脑膜瘤（WH0I）41例，用LsAB法做免疫组化染色，检测mdm2、bcl-2、AR的表达。结果在良性脑膜瘤中mdm2、bcl-2、AR的表达率分别为67％、62％、33％，三者之间没有相关关系。结论（1）是否能够作为抗性激素治疗疗效的筛选和／或预测指标，bcl-2比mdm2更有潜在价值。（2）AR在脑膜瘤中的促进生长作用的相对独立性，提示AR可以作为脑膜瘤对抗激素治疗的新靶点进一步研究。     

Loss of differentiation in intestinal metaplasia in cancerous stomachs. A comparative morphologic study.

229 stomachs resected for duodenal and gastric ulcer and carcinoma were examined with special regard to the morphological and histochemical pattern of intestinal metaplasia (IM). The results of qualitative and semiquantitative studies were analysed statistically. Whereas duodenal and gastric ulcer cases are best discriminated by the presence or absence of IM, the strongest discriminating factor between carcinoma and gastric ulcer is the content of goblet cells in metaplastic crypts. Metaplastic crypts lined exclusively with goblet cells producing sulfated acid glycoproteins could be identified in more than one third of the cancer cases. The increase in goblet cells coincides with a loss of the more differentiated cells in the metaplastic glands, such as enterocytes, APUD cells, or Paneth cells. This "enterocoli metaplasia" seems to be specific for cancer bearing mucosa and occurs more often in cancer of intestinal type; it may represent a form of a derepressive dedifferentiation. The significance of enterocoli metaplasia as a premalignant lesion remains to be elucidated.