Finger bougie method compared with pyloroplasty in the gastric replacement of the esophagus

To elucidate the necessity of pyloroplasty for the gastric tube through the posterior mediastinum in esophageal surgery, gastric emptying and duodenogastric reflux (DGR) were evaluated in 16 cases undergoing an anterior pylorectomy (group P) and in 16 cases treated by the finger bougie method (group F). First, the obstruction and reflux symptoms were examined based on a patient questionnaire using a brief scoring system. The median value of the symptom score showed the patients in P to have more symptoms than those in F; however, the difference was not significant (8.0 vs 6.0). Secondly, the swallowed Tc O₄ ⁻ (85 MBq) was counted using a gamma camera at three sites on the sternal bone in the upright position based on a gastric transit scintigram. Both the descending time of the RI peak and the clearance rates were similar between the two groups. Thirdly, intragastric 24-h pH monitoring was carried out. Antimony pH sensors were anchored 5 and 15 cm below the esophagogastrostomy. We could not find any difference between the two groups in both the % time pH>4 and %time pH>7. These findings thus revealed no big difference between groups P and F. The finger bougie method to drain the vagotomized posterior mediastinal stomach was found to achieve results similar to conventional pyloroplasty, while it was also simpler and safer.     

More than just a health issue: a review of current issues in the care of enterally-fed children living in the community

There are increasing numbers of children with a disability living in the community who require enteral tube feeds to optimize their nutritional status. Whilst there appears to be evidence of health gains, for some children there may also be serious and unintended social deprivations resulting from the need to be tube fed. This paper reviews the literature on support for children who are tube fed and makes a case for more coordinated and effective support services for families who are tube feeding a child at home. It is argued that national guidance should be developed which clarifies the position of all non-parent carers and staff who are willing to administer enteral tube feeds. Such guidance should also ensure that enterally-fed children have the same rights to educational and social services as other children and that families are given the opportunity to make informed decisions about the implications of enteral feeding prior to it being established.     

十二指肠腔内置管引流减压在毕-Ⅱ式胃大部切除术中应用疗效的观察

目的探讨防止毕-Ⅱ式胃大部切除术后十二指肠残端破裂发生的方法;方法对毕-Ⅱ式胃大部切除术中出现十二指肠残端水肿或血运差的病例,采取预防性十二指肠腔内置管引流减压的方法,收集临床资料、观察治疗效果;结果采取十二指肠腔内置管引流减压后,十二指肠残端破裂发生率明显下降;结论十二指肠腔内置管引流减压,可以预防十二指肠残端破裂的发生,并可拓宽溃疡穿孔病例采用胃大部切除术的适应证。     

Use of a Calibration Balloon Tube to Size the Pouch and Channel in Gastroplasty Procedures

Gastroplasty is currently one of the most common surgical procedures performed on the morbidly obese for weight loss. An adequate result can be assured only if the pouch that is created is less than 30 ml and the channel that connects that pouch to the distal stomach is approximately 1 cm in diameter. The current method to size the pouch is to occlude the esophagus and the outlet of the pouch and to measure with a manometer through a naso-gastric tube. We contend this method is both time consuming and adds to the potential of complications. Through the use of a calibration balloon tube the size of the pouch can be quickly and safely estimated. It can also be used to size the channel between the pouch and the distal stomach and check for leaks. The technique of how this tube has been used over the past 6 years is described. By the use of a calibration balloon tube, three problem areas in gastric stapling surgery for morbid obesity are avoided, namely: inappropriate pouch size, inappropriate channel size and postoperative leaks.     

Gastrostomy and oesophagoplasty with a flap from the greater curvature of the stomach as stages of surgical and combined treatment of cancer of the thoracic oesophagus

Four-hundred fifty-eight patients with cancer of the oesophagus were subjected to revisional laparotomy. Metastases into subphrenic lymph nodes were registered in 24% of the cases with a tumor in the bronchial segment; 42% with tumor in the subbronchial segment; 48% with tumor in the retropericardial segment; 71% with tumors in the sub-, intra-, and supraphrenic segments of the oesophagus. In 345 cases, laparotomy was followed by tube gastrostomy (Beck—Carrel method) with two operative deaths. Fifty-six patients in good condition with a small tumor in the middle part of the oesophagus (≤5 cm) without any abdominal metastases were subjected to primary oesophagoplasty: a 30–32-cm tube was formed out of the greater curvature of the stomach and placed retrosternally; gastrostomy was performed on the level of the thyroid cartilage (without any operative deaths). In two weeks, extirpation of the thoracic part of the oesophagus (with preoperative irradiation) was performed on patients with no abdominal metastases. Then the patients with primary oesophagoplasty were subjected to oesophago-gastrostomy of the neck. From six to 12 months following the combined treatment, the gastrostomy tube of 45 patients was lengthened to 30–32 cm and used for retrosternal oesophagoplasty (six operative deaths). Oesophagoplasty was performed on 14 patients during the extirpation of the oesophagus (six operative deaths).     

分泌性中耳炎咽鼓管及鼓室黏膜的光镜及电镜观察

目的：探讨分泌性中耳炎的发病原因，为临床治疗提供理论依据。方法：通过微波烧灼双侧咽鼓管口，建立分泌性中耳炎动物模型。光镜观察比较咽鼓管管腔及黏一软骨膜和鼓室黏膜变化。电镜观察咽鼓管鼓室段暗颗粒分泌细胞及其表面活性物质样板层体的变化。结果：各组咽鼓管管腔通畅，咽鼓管黏一软骨膜不易受炎症浸润及负压影响。鼓室黏膜水肿、增生、炎性细胞浸润明显，暗颗粒细胞分泌功能受损，表面活性物质板层体结构明显减少或消失。结论：咽鼓管黏一软骨膜在分泌性中耳炎发病过程中起重要作用。表面活性物质减少与分泌性中耳炎的发生密切相关。     

神经管发育不良患儿及其核心家庭MTHFR基因A1298C多态性分布的研究

目的　通过对神经管发育不良 (NDTs)患儿及核心家庭MTHFR基因A1 2 98位点多态性分布的研究 ,探讨该基因多态性与NDTs之间的关系。方法　 2 0 0 0年 9月～ 2 0 0 2年 3月 ,40例 3～ 1 5岁NDTs患儿 (男 2 8例 ,女 1 2例 )及其中 2 6个核心家庭进行研究。应用聚合酶链反应 限制性片段长度多态性分析 (PCR RFLP)技术 ,分析MTHFR基因第 1 2 98位核苷酸基因型 (野生型、杂合型、突变纯合型 )的分布情况 ;并对 2 6个核心家庭进行以父母为对照的病例对照研究 ,计算传递失衡指数 (TDT)及基于单体型的单体型相对危险度 (HHRR)。结果　NDTs患儿、核心家庭与正常对照中均未发现纯合突变。基因型构成比采用 χ2 检验 ,NDTs患儿及患儿母亲野生型分别占 1 7.50 % ,1 1 .54 % ,杂合型分别占 82 .50 % ,88.46 % ,与正常对照之间差异无显著性意义 (分别为P >0 .2 5 ;P>0 .90 )。患儿父亲野生型占 30 .77% ,杂合突变型占 69.2 3 % ,低于正常对照 (P <0 .0 5)。等位基因频率比较采用u检验 ,患儿为 41 .2 5 % ,与对照间差异无显著性意义 (P >0 .0 5) ;患儿父母分别为69 .2 3 % ,88.46 % ,均高于正常对照 (P <0 .0 1 )。核心家庭分析结果 :TDT(χ2 ) =0 .36 ,P >0 .0 5 ;HHRR(χ2 ) =0 .369,P >0 .0 5。结论　MTHFR基因第 1 2     

分泌性中耳炎豚鼠的咽鼓管表面活性物质变化

目的　观察豚鼠分泌性中耳炎时咽鼓管内表面活性物质的变化 ,探讨表面活性物质在分泌性中耳炎发病中的作用。方法　建立豚鼠分泌性中耳炎动物模型 ,分析咽鼓管内表面活性物质的生化成分和活性变化 ,同时观察给外源性表面活性物质治疗后咽鼓管内表面活性物质的变化。结果　豚鼠分泌性中耳炎模型组表面活性物质主要成分减少 ,磷脂酰胆碱 (phosphatidylcholine ,PC)和磷脂酰乙醇胺 (phosphatidylethanolamine ,PE)分别是 (19 9± 1 7) %和 (36 8± 2 7) % ,而正常组的PC和PE分别是 (2 5 7± 2 1) %和 (43 7± 3 8) % ,P值均 <0 0 0 1。模型组最低表面张力 (minimumsurfacetension ,γmin)为 (18 5± 2 4 )mN/m ,比正常组 (7 6± 0 8)mN/m升高 ,P <0 0 0l。给外源性表面活性物质治疗后 ,PC和PE增高 ,分别为 (2 3 3± 2 2 ) %和 (42 5± 3 6 ) % ,γmin降低 ,为 (11 8± 2 3)mN/m。结论　豚鼠分泌性中耳炎时咽鼓管内表面活性物质的主要生化成分明显减少 ,活性减弱 ,给外源性表面活性物质治疗后明显改善     

未破裂型输卵管妊娠136例阴道超声声像分析

目的 探讨未破裂型输卵管妊娠阴道超声声像特征及误诊原因。方法 回顾性分析经临床和病理对比的136例未破裂型输卵管妊娠病例的F)1道超声声像特征。结果 宫外胚囊声像35例，卵巢旁小包块58例，盆腔一侧橄榄形或管状包块43例，误诊5例。结论 未破裂型输卵管妊娠阴道超声声像有一定特征，其共性为卵巢旁境界清晰，形态规则不均质包块。     

20例原发性输卵管癌组织中ER、PR与p~(53)蛋白的表达

目的：分析原发性输卵管腺癌的ＥＲ、ＰＲ及ｐ５３蛋白的表达，研究其与该肿瘤的临床分期、病理分级及患者预后的关系。方法：材料选自２０份原发性输卵管腺癌及１０份正常输卵管组织的存档石蜡包埋标本，采用免疫组化法检测。结果：在２０份原发性输卵管癌标本中，ＥＲ、ＰＲ的阳性表达率分别为２５％和１５％，稍高于正常输卵管组的１０％，但差异无显著性（Ｐ＞０．０５）；ｐ５３蛋白在癌症组的阳性表达率为４０％，对照组则无１例阳性表达，差异有显著性（Ｐ＜０．０５）；ｐ５３蛋白在晚期、分化差及预后不良的输卵管癌病例中的表达呈上升趋势，但未达到统计学意义（Ｐ＞０．０５）；对侧输卵管炎症的存在与ｐ５３蛋白的阳性表达呈负相关（Ｐ＜０．０５）。结论：在原发性输卵管癌中，ＥＲ、ＰＲ有一定程度的表达，但均较低；ｐ５３基因的突变可能参与了该肿瘤的发生，并可作为综合判断其恶性程度及患者预后的指标之一。