Unusual case of epigastric heteropagus twinning

Asymmetrical conjoined twins or heteropagus twins are extremely rare. They are characterized by an incomplete component (parasite) that is normally smaller and dependent on the host (autosite). In cases of an epigastric heteropagus twin, the insertion occurs in the epigastrium. There are few reports of epigastric heteropagus twinning in the English-language literature. The authors report an extremely rare case of epigastric heteropagus twinning in which the parasite presented with head, thorax, and a rudimentary heart.     

The influence of different VEGF administration protocols on the perfusion of epigastric flaps in rats

In this study we investigated the impact of the time at which vascular endothelial growth factor (VEGF) was given on the overall survival of flaps and time of the achievement of full perfusion in the rat epigastric flap model. Epigastric flaps were raised in 144 rats. VEGF was given to 108 rats at different time points. Perioperatively blood flow, velocity, haemoglobin (Hb) concentration, and oxygen saturation were measured non-invasively using laser-Doppler spectrophotometry. On postoperative days 3, 5, 7, or 10, the pedicle of the flap was ligated. One week later, the flap was harvested for immunohistochemical assessment of the density of microvessels. Differences significant from those in the control group were found in all specimens 3 and 5 days after the first operation, whereas no differences in the area of necrosis were detected after 7 and 10 days. Preoperative values of measured Hb (p < 0.0001, 95% confidence interval (CI) 0.57 to 1.02), flow (p < 0.0001, 95% CI −0.32 to −0.13), and velocity (p < 0.0001, 95% CI 0.48 to 1.89) predicted necrosis. After ligation of the pedicle, SO₂ (p < 0.0001, 95% CI −1.12 to −0.83) and flow (p < 0.0001, 95% CI −0.38 to −0.26) were prognostic factors. The topical use of VEGF increases overall survival of flaps and decreases the time needed for a free flap to achieve full perfusion. The time of application of VEGF has no part in the postoperative course. The perfusion of vascularised free flaps in their wound beds was achieved between postoperative days 5 and 7 in the control group and postoperative days 3 and 5 after VEGF had been given.     

中药超微饮片与传统饮片治疗胃脘痛的对比研究及临床推广评价

目的对比研究附子理中汤超微饮片与传统饮片治疗胃脘痛的临床疗效,为中药超微饮片的临床推广提供参考依据。方法选择2010年5月~2013年5月间笔者所在医院中医诊断为胃脘痛并且采用附子理中汤治疗的患者共300例,根据药材不同分为两组,甲组160例采用中药超微饮片治疗,乙组140例采用传统中药饮品治疗,对两组患者临床疗效、症状积分、控制率、患者满意度等进行对比。结果治疗7 d,甲组临床总有效率95.63%,乙组为92.14%,两组临床疗效相当,差异无统计学意义(P>0.05)。用药第3天,甲组症候积分显著低于乙组症候积分,差异有统计学意义(P<0.05)。治疗结束3个月后,甲组临床控制率81.88%,显著高于乙组63.57%,差异有统计学意义(P<0.05)。甲组患者满意率86.88%,显著高于乙组55.71%,差异有统计学意义(P<0.05)。两组患者不良反应发生率无显著差异(P>0.05)。结论附子理中汤超微饮片治疗胃脘痛临床疗效满意,值得临床推广应用。     

足三里穴位注射维生素B_(12)治疗胃脘痛的疗效观察

目的探讨足三里穴位注射维生素B_(12)治疗胃脘痛的疗效。方法 2011年1月～2012年1月80例胃脘痛患者,随机分为观察组和对照组,两组各40例进行疗效的比较,对照组仅给予常规药物治疗,观察组在此基础上辅以足三里穴位注射维生素B_(12)。结果胃脘痛患者观察组总有效率92.5%,对照组总有效率70.0%,两组疗效差异有显著性(P<0.01)。结论足三里穴位注射维生素B_(12)治疗胃脘痛可以明显减轻患者临床症状,方法简单,安全有效,值得推广。     

莫沙必利治疗餐后不适综合征和上腹痛综合征随机、双盲、安慰剂对照研究

背景：莫沙必利作为一种促胃肠动力药早已被推荐用于治疗功能性消化不良（FD），然而目前遵循罗马Ⅲ标准FD诊断分型和症状评估原则进行的莫沙必利治疗FD的临床研究尚不多见。目的：评估莫沙必利改善餐后不适综合征（PDS）和上腹痛综合征（EPS）症状的疗效和安全性。方法：病例连续选自2006年12月-2007年9月在上海仁济医院消化内科门诊就诊、符合罗马ⅢFD诊断标准中PDS和EPS诊断的患者。先经1周安慰剂筛选期，无安慰剂治疗反应者随机进入治疗流程组合A或B，给予莫沙必利5mg tid×1周或安慰剂1片tid×1周，然后进入1周药物清洗期（安慰剂1片tid），最后给予安慰剂或莫沙必利继续治疗1周。各阶段治疗前和治疗后分别行FD症状评估。结果：共纳入FD患者83例，安慰剂总有效率为19．3％，67例对安慰剂无治疗反应者进入莫沙必利疗效观察研究．随机进入治疗流程组合A或B者分别为34例和33例。与安慰剂治疗相比，莫沙必利可显著降低患者的总症状积分（14．4±6．8对1．4±1．3，P〈0．05），对PDS的餐后饱胀不适、早饱症状和EPS的上腹部疼痛和烧灼感症状均有显著治疗作用。莫沙必利对PDS和EPS治疗的总有效率分别为79．4％和60．6％，差异有统计学意义（P〈0．05）。结论：莫沙必利可明显改善FD患者的临床症状，对PDS和EPS均有治疗效果，对PDS的有效率优于EPS，是安全、有效的FD治疗药物。     

Epigastric hernia and its etiology

Abstract Background. Controversies still prevail as to how exactly epigastric hernia occurs. Both the vascular lacunae hypothesis and the tendinous fibre decussation hypothesis have proved to be widely accepted as possible explanations for the etiology. Patient. We present a patient who suffered from early-onset epigastric hernia. Conclusions. We believe the identification of the ligamentum teres and its accompanying vessel at its fascial defect supports the vascular lacunae hypothesis. However, to further our understanding, biopsy of the linea alba in patients with epigastric hernias is indicated. Electronic Publication     

Perforated ileal diverticulitis

An atypical presentation of ileal diverticulosis definitively diagnosed and treated with laparoscopy is presented. While jejunoileal diverticula are often asymptomatic, they may lead to chronic or acute symptoms. The large majority of complications secondary to small-bowel diverticulitis present with an acute abdomen similar to appendicitis but they also may appear with atypical symptoms. As a result, identification of jejunoileal diverticulosis can be quite difficult and surgery is often required in order to reach an absolute diagnosis. Surgical exploration, resection of the involved segment, and primary reanastamosis may be indicated in instances of symptomatic diverticular disease of the small bowel. Current laparoscopic techniques make this procedure well suited for both diagnosis and treatment of jejunoileal diverticula. In this report, the surgical incision was directed and limited under laparoscopic guidance while still allowing the benefit of thorough examination of the abdominal contents.     

半夏泻心汤加减治疗慢性浅表性胃炎临床观察

[目的]观察半夏泻心汤加减治疗慢性浅表性胃炎疗效。[方法]对65例门诊患者使用半夏泻心汤(半夏10g,黄连3g,黄芩10g,干姜8g,党参12g,川朴6g,炒二芽各30g,陈皮6g,炙甘草6g,痞闷重加枳壳、佛手各10g)肝气不舒加郁金10g,柴胡6g;胃阴亏虚加石斛10g,北沙参12g;气滞血瘀疼痛加元胡10g;噫气较频加旋覆花15g,代赭石20g;泛酸明显加乌贼则骨12g,煅瓦楞子30g。1剂/d,水煎取400mL,分2次早晚2温服。连续治疗1月为1疗程。服药期间忌烟酒,辛辣,生冷,油腻,坚硬食品;并增加室外体育活动;调情志,适寒温。观测临床症状、胃黏膜状况、幽门螺旋杆菌。连续治疗1疗程,判定疗效。[结果]痊愈25例,显效30例,好转6例,无效4例,总有效率93.85%(61/65)。[结论]半夏泻心汤加减治疗慢性浅表性胃炎疗效肯定,经济实用,患者容易接受,值得推广。     

反流性食管炎病因病机研究简况

反流性食管炎病因病机为饮食失节、情志不遂、禀赋不足、外邪侵袭等,与肝脾胃肺关系密切,临床重视对肝郁、肝火的辨治,以和胃降逆为治疗大法,重视调节肺气,恢复其肃降之性。