Emergency Department Presentation of Superior Mesenteric Artery Syndrome: Two Cases in Marine Corps Recruits

Background: Superior mesenteric artery (SMA) syndrome is a relatively rare etiology of proximal intestinal obstruction. Obstruction results from marked narrowing of the angle between the SMA and aorta, causing compression of the third portion of the duodenum, most commonly as a result of precipitous weight loss. Intermittent non-specific symptoms at presentation often result in a delayed diagnosis, thus the importance of being aware of this condition. Objective: To familiarize emergency physicians with the presentation of SMA syndrome and discuss its diagnosis and management in the emergency department (ED). Case Report: We present two cases of SMA syndrome identified in Marine Corps recruits presenting to our ED. Conclusion: Emergency physicians should include SMA syndrome in the differential diagnosis of abdominal pain and vomiting in individuals with predisposing factors.     

Hypotonic duodenograms of postbulbar duodenal lesions: Pictorial essay

General features are described and examples are provided of the radiological manifestations of postbulbar duodenal lesions, particularly the findings on hypotonic duodenograms. Hypotonic duodenography does not always reveal the characteristic findings of postbulbar duodenal lesions, but it helps to evaluate luminal stenosis and diagnose disease entities even in lesions that show non‐specific findings. Radiologists should be familiar with the radiological findings of postbulbar duodenal lesions and know which kinds of lesions can affect the postbulbar duodenum. This is important in making a differential diagnosis and in preventing delays in diagnosis.     

原发性十二指肠恶性肿瘤的诊治

目的：探讨原发性十二指肠恶性肿瘤的诊治方法。方法：回顾性分析29例患临床资料，并结合有关献分析原发性十二指肠恶性肿瘤的发病情况，癌前病变，误诊原因、手术及再手术的选择。结果：十二指肠恶性肿瘤以降部乳头区和腺癌最为常见；十二指肠绒毛状瘤是癌前病变之一；主要误诊疾病为阻塞性黄疸、消化性溃疡、胆总管结石、消化道出血及小肠梗阻；29例中行胰十二指肠切除术13例及改道短路手术9例，根治性切除率为44．83％。结论：原发性十二指肠恶性肿瘤发病率低，易误诊；术前最有效的诊断方法为十二指肠镜加活检和十二指肠气钡双重造影；治疗首选胰十二指肠切除术。     

胃型上皮化生、幽门螺杆菌与十二指肠溃疡关系的探讨

对60例十二指肠球部粘膜(溃疡和炎症)进行病理学和幽门螺杆菌(HP)检查,同时对全部病例测定空腹胃液pH值,并选择40例患者进行半年至二年随访观察。病理显示35例活动性十二指肠炎,同时检出中、重度胃型上皮化生和HP者占76.5％,而非活动性十二指肠炎仅占17.6％,HP只生长在胃型上皮化生区,随访病例提示随着溃疡的愈合和活动性炎症的消失,胃型上皮化生减轻,HP转阴或密度减少。本文结果表明胃型上皮化生、HP与十二指肠溃疡密切相关。     

闭合性十二指肠损伤的早期诊断及手术方式选择

目的探讨闭合性十二指肠损伤的临床特点、早期诊断及手术方式选择。方法回顾性分析1990年~2005年收治的19例闭合性十二指肠损伤病例资料。术前确诊3例(15.8%),术中确诊14例(73.7%),漏诊2例(10.5%)。结果19例均行手术治疗,其中行单纯十二指肠破裂修补术3例;十二指肠修补加带蒂浆肌片覆盖2例;十二指肠端端吻合术2例;十二指肠空肠端侧或侧侧Roux-en-Y吻合8例;十二指肠憩室化手术3例,胰头十二指肠切除1例。术后发生并发症7例(36.8%),其中十二指肠瘘4例,胰瘘1例,切口裂开2例。治愈16例(84.2%),死亡3例(15.8%)。结论掌握闭合性十二指肠损伤的特点,注重早期诊断、早期手术,加强术中探查,选择合理术式是提高治愈率,降低死亡率的关键。     

十二指肠损伤的治疗体会

目的：提高十二指肠损伤的诊治水平，方法：回顾总结该院1999年－2001年间收治的十二指肠损伤7例临床经验。结果：合并其他腹部脏器损伤86％（6／7），单纯十二指肠损伤14％（1／7）。损伤部位以十二指肠降部为多占71％（5／7），水平部和球部各占14％（1／7），术后并发症发生率28％（2／7）、病死率14％（1／7）。结论：掌握十二指肠损伤的特点，早诊断、早手术、术中认真探查，掌握好检查指征，选择合理恰当术式，加强术后管理，可提高治愈率。     

十二指肠平滑肌肉瘤破裂致腹膜炎一例

[背景 ]十二指肠平滑肌肉瘤病例罕见 ,临床上因无特殊症状而容易误诊 .[病例报告 ]病人以右下腹痛 3d为主诉入院 ,经剖腹探查术诊断为十二指肠肿物破裂致腹膜炎 .[讨论 ]十二指肠恶性肿瘤发病率低 ,而肉瘤更为少见 .当发现患者有不明原因的消化道症状及贫血时 ,应警惕十二指肠恶性肿物的可能 ,进行早期诊断和治疗     

Pharmacological effects of rutin

It is well-known that flavonoids including rutin exert a wide range of pharmacological effects. This study was carried out for further characterization of the pharmacological effect of rutin. A significant rise in the serum 5-HT levels was found 2 h after the administration of rutin (25 mg kg^?1 i.p.). The same dose of rutin caused no significant change in the serum 5-hydroxytryptomine levels after 8 and 72 h when compared to controls. In the in vivo experiments, rutin (25 mg kg^?1 i.p.) was ineffective on the blood pressure and respiratory tract of the guinea-pigs in spite of its smooth muscle relaxant effects in the in vitro preparations. These findings strongly suggest a physiological antagonism in the effects of rutin in intact animals.     

胰—十二指肠—肾同期联合移植术护理综述

对Ⅰ型糖尿病并发尿毒症的患施行胰－十二指肠－肾同期联合移植术，能治愈糖尿病及纠正尿毒症，且改善患生活质量，作就手术前后的护理做了总结。护理内容包括术前供体选择、受体选择、心理护理及术后观察要点、并发症的观察、免疫抑制剂的应用，并作了疗效评价。