推拿牵引治疗腰椎间盘突出症疗效观察及血单胺类物质含量变化分析

采用推拿牵引疗法治疗腰椎间盘突出症31例,分析了患者治疗前后血中单胺类物质含量的变化。临床观察结果:治愈18例,显效8例,好转4例,无效1例,总有效率达96.8％。血中单胺类物质含量分析结果:5-NT、NE和5-HIAA的含量治疗后下降(P<0.05),表明推拿牵引对腰椎间盘突出症有明显的镇痛作用。     

The Effect of Laser Irradiation for Nucleus Pulposus: an Experimental Study

Abstract

Background: The radicular pain caused by disc herniation can be explained by two mechanisms: the compression of the nerve root by the herniated disc or the irritation of the nerve root due to chemical factors. Percutaneous laser disc decompression (PLDD) was introduced for the treatment of lumbar disc hernias in the 1980s. Decompression of the nerve root is assumed to be an effective therapeutic mechanism for PLDD. However, laser irradiation might reduce the chemical factors that cause nerve root irritation by altering intra–disc proteins. We used nerve conduction velocities (NCV) and levels of two chemical factors to evaluate the differences between the two groups in this in vivo study.

Methods: All rabbits had the nerve root in contact with the leakage from the nucleus pulposus. One group underwent laser irradiation for the leaking nucleus pulposus including the incision site of the disc and nucleus pulposus itself. The levels of two chemical factors, prostaglandin E2 and phospholipase E2, in the intervertebral disc were measured before and after laser irradiation.

Results: NCV in the laser–irradiated group was significantly faster than in the non–laser–irradiated group. The levels of chemical factors were significantly reduced after laser irradiation.

Conclusions: One of the mechanisms thought to be responsible for PLDD's effectiveness is a decrease in the chemical factors through protein alteration in the intervertebral disc by laser irradiation.     

牵引压弹斜扳三步法治疗腰椎间盘突出症临床观察及机理分析

采用牵引、压弹、斜扳三步法治疗腰椎间盘突出症９４例．以自拟三期疗效标准评定，优良率达９４％。观察发现Ⅰ期疗效优者，Ⅱ、Ⅲ期疗效亦优；反之则差。因此，主张Ⅰ期疗效差者，应及时进行手术治疗，以免延误病情。分析认为该疗法的机理在于：①可拉宽椎间隙，增加椎管内容积；②可松解神经根粘连，使突出物还纳或位移；③可纠正脊柱后关节紊乱，恢复其正常的生理平衡；④可放松脊旁肌肉．改善受压组织的血液供应。     

Enterocutaneous Fistula: a Rare Complication of Laparoscopic Adjustable Gastric Banding

Morbid obesity is a refractory disease with serious co-morbidities. Laparoscopic adjustable gastric banding (LAGB) has generally been a safe and effective method for achieving sustained weight loss. We report a man who presented after LAGB with persistent wound infection at the access port-site, which failed conservative management. Diagnostic laparoscopy found an enterocutaneous fistula from herniated bowel (in a Richter's hernia) into which the catheter had eroded. The small bowel and fascial defect were repaired. The catheter was then clipped and divided, and the port was removed.     

Computed Tomography Patterns in Small Bowel Obstruction after Open Distal Gastric Bypass

Background: Life-threatening small bowel obstruction (SBO) after Roux-en-Y gastric bypass can present with surprisingly minimal laboratory and plain x-ray findings. Based on a 10-year (1994-2003) experience of 1,409 open distal gastric bypasses, we present clinical and radiological findings in 29 patients with unusual forms of bowel obstruction. Methods: A retrospective chart review was conducted. A radiologist experienced in reviewing these in gastric bypass patients reviewed all computed tomography (CT) scans. Results: CT findings: The normal appearance and 7 recurring patterns of small bowel obstruction were identified. These include: 1) intussusception, 2) internal hernia through Petersen's space, 3) through Petersen's space and the mesenteric defect at enteroenterostomy, 4) through the mesenteric defect from the entero-enterostomy, 5) isolated biliary limb obstruction, 6) segmental non-anastomotic ischemia, and 7) internal hernia through bands. Clinical findings: 1 had peritonitis, and 1 had free air on plain film. WBC count was normal in 20/27 patients (74%) including 5/6 (83%) with dead bowel. 9/14 patients (62%) had "non-specific" findings on x-rays. 7 of these had an internal hernia (2 with volvulus and 2 with dead bowel), 1 had biliopancreatic limb obstruction, and 1 had peritonitis. Conclusion: Patients with SBO after distal gastric bypass may present with vague complaints and confusing laboratory and non-specific findings on x-rays. Delayed diagnosis can have catastrophic consequences. CT imaging with oral and intravenous contrast can be life-saving, and should be obtained in all gastric bypass patients with abdominal pain, particularly when all other parameters seem "normal". Unexplained abdominal pain should prompt exploration.     

Erosive Esophagitis and Barrett's Esophagus in Taiwan (A Higher Frequency than Expected)

In contrast to Western countries, erosiveesophagitis has been considered less common, Barrett'sesophagus presumed less frequent, and hiatal herniaextremely uncommon in the Orient. However, accelerated modernization and adoption of Western customshave resulted in marked life-style changes in manyAsians in the Orient that may potentially affect thefrequency of erosive esophagitis and Barrett's esophagus in this population. Our aim was to determinethe current frequency of erosive esophagitis, Barrett'sesophagus, and other gastroesophageal reflux diseasecomplications in self-referred Chinese patients undergoing upper gastrointestinal endoscopy inTaipei, Taiwan. Between July 1991 and June 1992, 464consecutive patients underwent endoscopy for a varietyof upper gastrointestinal symptoms at a major medical center. The presence of erosive esophagitis,strictures, Barrett's esophagus, and hiatal hernia wasrecorded. The extent of mucosal injury was determined byusing the Savary-Miller grading system. Sixty-six (14.5%) patients were found to have erosiveesophagitis, 9 (2%), Barrett's esophagus, and 32 (7%)hiatal hernias. Erosive esophagitis showed amale-to-female preponderance of 3.1:1. Disease severityincreased with age and peaked during the sixth andseventh decades. We concluded that in contrast toprevious experience, the Chinese population in Taiwanappears to have a higher frequency of erosiveesophagitis, Barrett's esophagus, and hiatal hernia.Increased fat consumption, aging, and other possiblefactors are suggested as possible mechanisms.     

Laparoscopic Closure of the Petersen Mesenteric Defect

Small-bowel obstruction secondary to internal hernia is a known postoperative complication of laparoscopic Roux-en-Y gastric bypass (RYGBP). Petersen's defect is the most common site of postoperative internal herniation. The authors describe their technique of closure of the infracolic component of the Petersen's defect using continuous non-absorbable suture material. The method has been used successfully to reduce the incidence of internal herniation after laparoscopic RYGBP.     

强直性脊柱炎误诊为腰椎问盘突出症40例分析

对４０例误诊为腰椎间盘突出症的强直性脊柱炎患者进行了分析，认为其误诊原因为：①临床拟诊错误，致使患者不能接受相应的Ｘ线平片及化验检查；②临床医生过于相信ＣＴ检查结果，忽视了病史及查体；③对坐骨神经痛的病因未能深入研究；④放射科医师对强直性脊柱炎的早期Ｘ线诊断缺乏经验。分析结果还表明，强直性脊柱炎多继发无症状性椎间盘膨出或突出，较少并发腰椎间盘突出症。治疗上前者主要应用抗风湿类药物辅以物理治疗，控制炎症发展，而后者需同时配合牵引及手法治疗。     

Helicobacter pylori Infection Has No Role in the Pathogenesis of Reflux Esophagitis

In a prospective study of consecutive patientswith reflux esophagitis and/or hiatal hernia andBarrett's esophagus, the prevalence of Helicobacterpylori was assessed. Antral biopsy specimens werestudied and a serum sample for detection of IgGantibodies against Helicobacter pylori was taken. As areference group patients presenting with a normalesophagus, stomach, and duodenum were taken. Refluxesophagitis was diagnosed in 118 patients, hiatal herniawithout esophageal inflammation in 109, and Barrett'sesophagus in 13. Helicobacter pylori was present in 74(30%) of these patients and in 204 (51%) of the reference group. Prevalence of Helicobacterpylori was significantly lower in all groups comparedwith the reference group (P < 0.001). There was nodifference when patients with esophagitis, Barrett'sesophagus, or hiatal hernia were compared. Patients withesophagitis and Helicobacter pylori in their antrum aresignificantly older than esophagitis patients withoutconcomitant Helicobacter infection, 61.5 (SD, 17) versus 53 (SD, 17) years (P < 0.001). Itis concluded that the prevalence of Helicobacter pyloriinfection in patients with gastroesophageal refluxdisease is significantly lower than in the reference group, irrespective of the severity ofesophagitis. Helicobacter pylori infection has no rolein the pathogenesis of reflux esophagitis.     

腹股沟斜疝的“五六评分法”与微创手术

目的　根据近代理论, 建立微创腹股沟疝修补术。方法　根据“五六评分法”,对36 例评分≤5 分初次发作的腹股沟斜疝男性患者,采用小切口,行疝囊高位结扎 内环口缩小手术,而不行腹股沟管的后壁修补。结果　整个手术时间约20 ～30 min ,手术后第3 d 出院并恢复正常工作。36 例均无手术并发症。随访1-5 ～2 年,无1 例复发。结论　根据腹股沟疝“五六评分法”设计的微创腹股沟疝修补术,简便、安全、创伤小,手术后恢复快,可在临床推广。