米索前列醇的临床应用

米索前列醇（misoprostol,米索）是人工合成的前列腺素E_1的衍生物,有多方面临床用途。80年代早期米索最先开始用于治疗消化性溃疡,尤其是对非甾体类抗炎药引起的胃十二指肠溃疡有明显疗效,对急性应激性溃疡也有预防作用。米索可引起腹泻,但因此也可治疗严重便秘的患者。随后发现米索对肝、肾有保护作用,还具明显抗炎、抗过敏作用;与其它抗早孕药合用,米索可使完全流产率大大提高;对人工流产术前的病人用米索可软化并扩张宫颈,从而减轻扩宫时病人的痛苦,使手术顺利进行。对米索的毒副作用研究发现其毒性主要表现在消化系统和雄性生殖系统,但一般比较轻微,无明显其它不良反应。故米索可谓一种高效、低毒的药物,值得临床推广。但男性患者在长期大量应用该药时需注意其对生殖系统的影响,孕妇应禁用。     

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.     

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.     

核素显像评价电刺激对健康青年人小肠运动功能影响的试验研究

目的利用放射性核素显像研究十二指肠电刺激对人小肠通过时间的影响。方法12例健康青年志愿者,男女各6例,年龄21～25岁,中位年龄23岁。在胃镜引导下留置导管至十二指肠水平部,并安置电极,将99mTc-DTPA(二乙撑三胺五乙酸)和乳果糖混合液注入导管,用单光子发射式计算机断层仪(SPECT)进行连续小肠显像。择日对受试者进行电刺激,刺激条件:频率13Hz、波宽300ms、刺激强度5mA的方波,采用上述方法进行显像。使用感兴趣区分析法,生成小肠时间-放射性曲线,计算出小肠半排时间(T50),比较刺激前后小肠半排时间的变化。结果电刺激前后小肠平均半排时间分别为(49.5±15.8)min和(29.6±10.9)min,刺激前后T50变化有统计学意义(P<0.01)。结论放射性核素显像能很好地反映小肠运动变化,十二指肠电刺激能明显加快小肠运动。     

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。