17例无绳胶囊内镜检查临床分析

目的通过对无绳胶囊内镜检查情况分析，评价胶囊内镜检查在临床上应用的效果。方法对17例疑小肠疾病或不能耐受胃镜检查的病人或体检者行胶囊内镜检查，并对其结果进行分析。结果所有病人检查无不适感，15例完成小肠检查，2例胶囊分别滞留于食管、胃。7例不明原因胃肠道出血中5例完成小肠检查。均发现了小肠病变。结论胶囊内镜检查是一种无痛苦、无创、安全的上消化道检查，是小肠疾病尤其是不明原因胃肠道出血诊断的首选方法。     

Pain induced by low-grade stress in patients with fibromyalgia and chronic shoulder/neck pain, relation to surface electromyography.

The mechanisms of pain causation in fibromyalgia (FMS) and chronic shoulder/neck pain (SNP) are still debated. We wanted to compare muscle activity and pain development during and after low-grade mental stress in FMS and SNP patients. Twenty-three women with FMS, 29 women with chronic SNP and 35 healthy women performed a stressful task lasting 60 min followed by a 30 min recovery period. We recorded surface electromyography over the trapezius, neck, temporalis and frontalis muscles. Subjects reported their pain at the corresponding locations together with the development of fatigue and perceived tension. Significant differences between FMS and SNP groups were not observed either for muscular or subjective responses. SNP patients and controls responded with more pain in the trapezius and neck regions than in the forehead, in contrast to FMS patients who had a more generalized pain response. Development of pain, tension and fatigue was not related to muscle activity for any group. We conclude that FMS and SNP patients have similar pain and electromyographic responses. The results suggest that similar pathophysiological mechanisms are involved although the responses are more generalised in FMS than in SNP patients. Muscular activity did not explain the pain which developed during the stressful task for either group. Pain lasted longer during recovery in both FMS and SNP patients compared to healthy controls, possibly a result of disease-related sensitisation in pain pathways.     

Gastric Barotrauma in a Scuba Diver: Report of a Case

Stomach rupture can occur as a consequence of the expansion of compressed air during rapid ascent after diving. We present the case of a middle-aged woman who suffered a gastric tear from surfacing too quickly after diving, and discuss the diagnosis and management of such patients by reviewing previously reported similar events. Gastric barotrauma should be suspected in divers who complain of abdominal pain, even in the absence of frank signs of peritoneal irritation. Although pneumoperitoneum is always present in these patients, it can also occur as a consequence of pulmonary barotrauma, making gastroscopy or radiological contrast studies, or both, essential for a definitive diagnosis. Surgical repair represents the treatment of choice for an active full-thickness tear and, if associated with arterial gas embolism or decompression sickness, should ideally be performed in a center where a category I (intensive care-capable) hyperbaric unit is available. Received: March 18, 2002 / Accepted: September 3, 2002 Reprint requests to: L.V. Titu     

胃良性和恶性病变组织中β-半乳糖凝集素3和接骨木凝集素的表达及其临床病理意义

Objective To study the expressive levels of galectin-3(gal-3) and sambucus nigra agglutinin (SNA) and their clinicopathological significance in the benign and malignant lesions of stomach. Methods EnVisonTM immunohistochemistry for assaying gal-3 expressive level and ABC cytochemistry for determining SNA expressive level were used in conventional paraffin-embedded sections from specimens of gastric cancer(n=49), peritumoral tissues(n=20), metastastic foci of lymph nodes(n=36), and different types of benign lesions(n=80). Results The positive rates of gal-3 and SNA were significantly higher in gastric cancer tissues than those in peritumoral tissues and different types of benign lesions (P<0.05, P<0.01). The positive cases of gal-3 and/or SNA in peritumoral tissues and benign lesions showed mild- to severe-atypical hyperplasia of mucous epithelial cells. No difference was found between the primary foci and metastatic foci in gal-3 and SNA expressions (P>0.05). The positive rates of gal-3 and SNA were significantly lower in histologic grade Ⅱ, infitrating depth T1,T2 and no-metastasis of regional lymph node than those in histologic grade Ⅲ, Ⅳ, infitrating depth T3,T4 and metastasis of lymph node in gastric cancer(P<0.05). The positive rates of gal-3 and SNA were higher in lymphnede metastatic site N1 and no-metastasis of distant organs than those in lymphnede metastatic site N2, N3 and metastasis of distant organs, but no significant difference was found (P>0.05). The consistence was found between the expression of gal-3 and SNA in gastric cancer tissues (χ2=6.59,P<0.05). Conclusions The expressive levels of gal-3 and SNA may be important molecular markers of lectins for reflecting the carcinogenesis, progression and biological behaviors in gastric cancer.     

肾组织移植对慢性肾功能衰竭大鼠促红细胞生成素的调节作用

目的研究鼠婴肾组织移植于肾包膜下对促红细胞生成素的调节作用,为临床应用治疗肾性贫血提供理论依据。方法以Wistar雄性大鼠建立慢性肾功能衰竭动物模型为受体,将鼠婴肾组织块多点植入受体肾包膜下。治疗期间用EPO酶联免疫(ELISA)试剂盒测定血清EPO水平;观察肾组织病理改变,用免疫组化方法检测EPO在移植物中的表达。结果①60d时D组血清促红细胞生成素(1.768±0.140)mu/mL高于B组(1.160±0.324)mu/mL(P<0.01),与C组(2.329±0.125)mu/mL也有差异(P<0.05)。②移植后60d,移植物的体积由1mm3增至3-4mm3大小,表面血管网丰富,光镜下见肾小球、肾小管结构正常;③移植物EPO免疫组化,发现移植物EPO着色颗粒主要分布于肾皮质的肾小管,明显多于病例对照组大鼠肾组织(P<0.05)。结论通过对移植物的形态观察和功能测定,证明肾组织移植是一种有效的治疗手段,有可能为慢性肾性贫血提供一种新的途径。     

Predicting work status following interdisciplinary treatment for chronic pain.

The effectiveness of interdisciplinary treatments for chronic pain is well established. In general, these treatments decrease psychosocial distress and increase physical abilities. Further, return to work rates following interdisciplinary treatment tend to be quite high. Previous studies have highlighted a number of factors that individually influence return to work rates; however, there is a need for more comprehensive and unified models that allow an evaluation of the inter-relations among these factors. The present investigation examined how demographic and treatment outcome variables interacted to influence post-treatment return to work rates in a sample of individuals with chronic pain following interdisciplinary treatment. Results indicated that patient age, lifting ability, pain duration, depression level, and reported disability were individually related to return to work; however, when these variables were evaluated relative to one another, level of depression and patient age had the best ability to predict post-treatment work status. These results add to the literature by specifically highlighting post-treatment factors that best discriminate patients who had returned to work from those that had not. Furthermore, they provide evidence that general emotional distress is perhaps the most important predictor of work status following treatment.     

Survival after gastric adenocarcinoma resection: Eighteen-year experience at a single institution

Gastric adenocarcinoma is the second leading cause of cancer death worldwide. In Western series, survival rates vary widely and are generally lower than those reported from Eastern series. We performed a retrospective analysis of cases operated on at the Johns Hopkins Hospital over the past 18 years and collected data on demographics, tumor characteristics, pathologic stage, treatment methods, complications, survival time, and other relevant factors. Survival according to stage of disease, Lauren tumor type, tumorlocation,time period, andadministration of adjuvant therapy wasanalyzed, andresultswerecompared with those of other Western series. During this period, 436 patients with gastric adenocarcinoma underwent resection. We have shown a statistically significant association between survival and margin status, stage of disease, and Lauren tumor type. Overall 5-year survival was 26%, and 5-year survival after R0 resection was 33%. No significant difference was detected between survival and tumor location, time period of treatment, or administration of adjuvant therapy. Analysis of various Western series reveals major differences between the cohorts under study, such as stage of disease, extent of resection, tumor type, and tumor location. Many of the reported differences among Western series may be due to cohort differences, such as stage of disease, extent of resection, tumor type, and tumor location.     

Spinal Cord Stimulation in a Mouse Chronic Neuropathic Pain Model

Objective. Development of a spinal cord stimulation (SCS) system in a mouse model of chronic neuropathic pain. Materials and Methods. Male C57BL/6 mice (N = 6) underwent a partial ligation of the sciatic nerve. Development of mechanical hyperalgesia was tested using the withdrawal response to tactile stimuli with the von Frey test. An SCS system was implanted on day 14. On day 16, the mice were stimulated for 30 min (f = 50 Hz; pulse width 0.2 msec and stimulation at 2/3 of motor threshold). Repeated measure analysis of variance (anova ) and paired Student's t‐test with Bonferroni correction were used to evaluate the development of mechanical hyperalgesia and the therapeutic effect of SCS. Results. Five out of six mice developed marked mechanical hyperalgesia in the nerve‐lesioned paw that persisted for the duration of the study (16 days). No changes contralateral to the injury were observed. In four out of five mice, a successful implantation of the electrodes followed by stimulation was achieved. Then, SCS resulted in a fast and robust increase of withdrawal threshold back to pre‐injury levels. After termination of the SCS, the withdrawal threshold of the ipsilateral paw slowly decreased. No effect of SCS on the contralateral paw was noted. Conclusion. The development of a mouse SCS system is described that is practical in use, is reproducible, and shows a comparative therapeutic effect in treatment of chronic neuropathic pain as reported in rat.