Effects of erythromycin on the propulsive motility of upper gastrointestinal tract in rats

The differences between the postprandial mixing or propulsion and the interdigestive motility of the gastrointestinal (GI) tract are already known. Earlier studies showed dose-dependent differences in the effects of erythromycin on interdigestive motility. The various GI side-effects (vomiting, diarrhoea) also suggest that there are different effects of erythromycin on the GI motility. The aim of our study was to examine postprandially the propulsive effects of different doses of erythromycin on the movement of intraluminal contents in the upper GI tract of the rat. The animals were fasted for 24 h before the experiments but water was given freely. The rats received 1.5 ml 1.5% methylcellulose painted with 0.05% phenol-red intragastrically (test solution). Erythromycin(E. lactobionate) was given intravenously at doses of 0.05, 0.1, 0.25, 0.5, 1.0 and 5.0 mg/kg 15 min before the administration of a test solution. The animals were sacrificed 20,60 and 120 min after administration of methylcellulose, when the distance between the front of the painted intraluminal contents and the pylorus was measured and expressed as a percentage of the total length of small intestine. The phenol-red content in the stomach and small intestine was measured spectrophotometrically and the gastric emptying was calculated from the ratio of the measured total and intestinal phenol-red content. Our results showed that the small doses of erythromycin (0.1 and 0.25 mg/kg) accelerated gastric emptying after 20 min but did not change significantly the propulsive motility of upper small intestine; however, large doses of erythromycin (1.0 and 5.0 mg/kg) decreased gastric emptying and upper GI motility after 20 and 60 min. In summary, the prokinetic action of small doses of erythromycin was demonstrated, but its effecttime on GI motility is short and the ratio of the stimulating and inhibitory doses is 1:10. This paper was presented at the Section of IUPHAR GI Pharmacology Symposium on ’Biochemical pharmacology as an approach to gastrointestinal disorders (basic science to clinical perspectives)‘, October 12-14, 1995, Pécs, Hungary.     

The value of the acoustic analysis of pathological infant cry and breathing noise in everyday practice

During a period of twenty years [1969-1988] the author has observed 614 cases of congenital malformations and noninflammatory diseases of the larynx in infants and young children, Budapest. He summarizes the most characteristic symptoms of laryngeal pathology in infants, and discusses the diagnostic possibilities. Among the latter, spectrographic analyses complemented by auditory evaluation of pathological cry and different breathing noises play an important role. Based on his investigation author differentiates 20 kinds of pathological crying sounds and 4 basic forms of stridor. He describes the acoustic attributes of different pathological sound phenomena and summarizes characteristic voice changes.     

Angiodysplasia as the cause of massive lower gastrointestinal hemorrhage in a young adult

PURPOSE: This study was undertaken to clarify the importance of bleeding vascular ectasia of the colon as the etiology of massive lower gastrointestinal hemorrhage in patients 40 years of age or younger. METHODS: An otherwise healthy 21-year-old male was admitted to a tertiary medical center with massive lower gastrointestinal hemorrhage. Technetium-labeled red blood cell scan, selective visceral angiography, and colonoscopy identified the source of bleeding as vascular abnormality of the descending colon. Segmental colonic resection was performed. RESULTS: Histologic review of the specimen demonstrated a vascular ectasia. The patient recovered uneventfully and has had no further stigmata of hemorrhage. A review of the literature was undertaken to make clear the significance of vascular ectasia as the source for massive colonic hemorrhage in the young adult. CONCLUSION: This is the first report that documents histologically a vascular ectasia as the source of massive lower gastrointestinal hemorrhage in an otherwise healthy patient less than 40 years of age. Vascular ectasia is an uncommon cause of lower gastrointestinal hemorrhage in the young adult.The Chief, Bureau of Medicine and Surgery, Navy Department, Washington, DC, Clinical Investigation Program sponsored this report #84-16-1968-532, as required by HSETCINST 6000.41A. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.     

应用上唇外侧组织瓣旋转修复下唇缺损

目的:探求上唇外侧组织瓣在修复较大面积下唇缺损中的作用。方法:根据患者下唇缺损情况,设计上唇外侧组织瓣,旋转后插入缺损组织,同时在缺损吻合处,将上层外侧旋转瓣内侧粘膜肌肉向外牵拉形成部分新的红唇,然后逐层相对缝合,修复缺损。结果:自2003年1月应用此方法修复患者6例,术后随访1～2年,唇部外形好,无流涎,无口闭合不全,效果满意。     

Chronic intestinal pseudo-obstruction: manifestations, natural history and management

Chronic intestinal pseudo-obstruction (CIPO) is a rare pathological condition characterized by a marked derangement of gut propulsive motility mimicking mechanical obstruction, in the absence of any lesion occluding the gut lumen. This disease is often associated with a disabling and potentially life-threatening complications and is still too often unrecognized even in referral centres. As a result, patients receive neither appropriate care nor recognition of their severe health condition. Medical and surgical therapies are often unsatisfactory and long-term outcome turns out to be poor in the vast majority of cases. This article focuses on the main clinical features, the management and long-term outcome of patients affected by CIPO, with particular emphasis on those aspects which remain a matter of debate.     

Multi-detector CT angiography for lower gastrointestinal bleeding: Can it select patients for endovascular intervention?

This is a retrospective review of the results at our institution of using multi-detector CT angiography (CTA) to localise lower gastrointestinal (GI) bleeding. We hypothesised that in our patient population: (i) CTA was unlikely to demonstrate bleeding in patients who were haemodynamically stable; (ii) in haemodynamically unstable patients in whom CTA was undertaken, the results could be used to select patients who would benefit from catheter angiography; and (iii) in haemodynamically unstable patients in whom CTA was undertaken, a subgroup of patients could be identified who would benefit from primary surgical treatment, avoiding invasive angiography completely. A retrospective review was conducted of the clinical records of all patients undergoing CTA for lower GI haemorrhage at our institution between 1 January 2005 and 30 June 2007. Out of the 20 patients examined, 10 had positive CTAs demonstrating the bleeding site. Nine were haemodynamically unstable at the time of the study. Four patients with positive CT angiograms were able to be treated directly with surgery and avoided invasive angiography. Ten patients had negative CTAs. Four of these were haemodynamically unstable, six haemodynamically stable. Only one required intervention to secure haemostasis, the rest stopped spontaneously. No haemodynamically stable patient who had a negative CTA required intervention. CTA is a useful non-invasive technique for localising the site of lower GI bleeding. In our patient population, in the absence of haemodynamic instability, the diagnostic yield of CTA was low and bleeding was likely to stop spontaneously. In haemodynamically unstable patients, a positive CTA allowed patients to be triaged to surgery or angiography, whereas there was a strong association between a negative CTA and spontaneous cessation of bleeding.     

子宫内膜萎缩疗法治疗青春期功血362例临床研究

目的：探讨子宫内膜萎缩疗法治疗青春期功血（DUB）的止血效果。方法：将362例平均分为观察组（采用炔诺酮、戊酸雌二醇联合疗法止血）和对照组（单用炔诺酮子宫内膜萎缩疗法止血），两组各181例，比较两组的止血效果。结果：观察组和对照组止血有效率分别为96．13％（174／181）和92．27％（167／181），两组比较差异无统计学意义（踟105）；观察组和对照组控制出血时间分别为（28．69±14．87）h和（29．72±15．34）h，两组比较差异无统计学意义（踟．05）。观察组和对照组的完全止血时间分别为（32．80±19．10）h和（47．30±18．60）h，两组比较差异有统计学意义（／9〈0．05）。观察组和对照组的住院天数平均为（6．10±2．80）d和（6．9±2．60）d，观察组住院时间短于对照组（P〈0．01）。结论：炔诺酮止血疗法和炔诺酮、戊酸雌二醇联合疗法治疗青春期功血效果均较好，但炔诺酮、戊酸雌二醇联合疗法治疗效果更佳。     

IgE-mediated anaphylactic reaction to purified and recombinant factor VIII in a patient with severe haemophilia A

We report a 51-year-old patient with severe haemophilia A developing a severe life-threatening anaphylactic reaction to recombinant factor VIII (rFVIII). Anaphylactic reactions are a rare but well-known side effect of FVIII products. The nature of these reactions could not be clarified as previous studies failed to demonstrate a specific IgE response. Here, we could prove a grade 3 anaphlyactic reaction as an IgE-mediated response to rFVIII for the first time by Western blotting.     

第2代(温控)射频消融子宫内膜切除术

目的探讨第2代（温度控制）射频消融子宫内膜切除术的疗效、安全性和可行性。方法2004年9月-2006年2月由上海市4家医院联合开展一项多中心、前瞻性研究,完成功能性子宫出血温控射频消融子宫内膜切除术81例。在超声监护下,射频治疗以温度控制模式输出功率50 W、温度设定85℃,按照两侧宫角、宫底、宫体、下段部位顺序射频消融子宫内膜。每个治疗点治疗时间为4 min。结果81例术后随访4-17个月。术后6个月随访70例,其中闭经48.6%（34/70）,点滴状月经41.4%（29/70）,少量月经10%（7/70）,总有效率为100%（70/70）。术后12个月随访67例,其中闭经56.7%（38/67）,点滴状月经29.9%（20/67例）,少量月经9.0%（6/67）,正常月经量3.0%（2/67）,月经量过多1.5%（1/67）,总有效率98.5%（66/67）。结论温控射频消融子宫内膜切除术不仅使患者的异常子宫出血在保留子宫的情况下得到有效的治疗,同时具有操作方便、治疗时间短、并发症少、术后恢复快等特点。     

下消化道出血的少见病因

下消化道出血病因复杂,随着诊疗技术的发展,人们对一些少见病因有了越来越多的了解,现就部分少见病因作一综述,以帮助临床诊断与治疗.