贲门溃疡104例内镜检查分析

目的:通过贲门溃疡胃镜下表现的分析,探讨贲门良性溃疡与恶性溃疡的区别及并发症的差异.方法:纤维胃镜检查的同时采取相应部位的病理标本并行病理学检查,记数资料采用卡方检验比较差异性.结果:病例共104例,其中良性溃疡66例,恶性溃疡30例,癌前病变8例,恶性溃疡73%合并有慢性萎缩性胃炎,良性溃疡25%合并有十二指肠球部溃疡.结论:贲门良性溃疡(16/66)与十二指肠疾患密切相关,恶性溃疡(22/30)于慢性萎缩性胃炎密切相关,临床工作中遇有慢性萎缩性胃炎患者,应高度警惕,定期随访,及时发现恶变.     

The Clinical Effects of Alantoin Powder for Gargleon Periodontal Diseases and Aphthous Ulcer

ＴｈｅＣｌｉｎｉｃａｌＥｆｅｃｔｓｏｆＡｌａｎｔｏｉｎＰｏｗｄｅｒｆｏｒＧａｒｇｌｅｏｎＰｅｒｉｏｄｏｎｔａｌＤｉｓｅａｓｅｓａｎｄＡｐｈｔｈｏｕｓＵｌｃｅｒＹｕＷｅｉｙｉ（俞未一）ＳｕｎＷｅｉｂｉｎ（孙卫斌）ＤｅｐａｒｔｍｅｎｔｏｆＳｔｏｍａｔｏｌ...     

A Case of Postbulbar Duodenal Ulcer with Jaundice

Abstract: A 63-year-old man was hospitalized because of jaundice and anorexia. An upper gastrointestinal series and hypotonic duodenography revealed circumferential sclerosis and stenosis of the duodenal wall. Endoscopic examination disclosed an ulcer, the upper margin of which was located at the papilla of Vater. The papilla was situated in the base of the ulcer. Endoscopic retrograde cholangiopancreatography disclosed mild dilatation of the common bile, intrahepatic bile and pancreatic ducts, but with neither severe stenosis nor occlusion. Nevertheless, there was some degree of circumferential compression and mild stenosis of the terminal portions of the bile and pancreatic ducts, as potential causes of obstructive jaundice in this patient. Computed tomographic examination of the abdomen revealed a tumorous lesion at the duodenal bulb. Because malignancy in the duodenum could not be ruled out, a pancreatoduodenectomy was performed. Histopathological examination showed a postbulbar duodenal ulcer, associated with inflammation of the papillary orifice and fibrosis of the region near the papilla. There was no evidence of a tumorous lesion. In this case, a postbulbar duodenal ulcer may have caused obstructive jaundice.     

磷酸铝凝胶剂的研制

以微粒沉降速度、粒度分布、粘度大小等为指标，利用正交试验法筛选出磷酸铝凝胶剂的最佳处方。结果表明，磷酸铝凝胶剂的沉降容积比可达９３．１％，其粒度均小于１０μｍ，而且沉降速度较小。     

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.     

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。     

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.