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2.
目的探讨扬州地区肝硬化食管静脉曲张初次出血患者诊治特点。方法回顾性分析2010年1月-2013年12月苏北人民医院消化内科收治的80例肝硬化食管静脉曲张初次出血患者病例资料。计数资料用率或构成比表示,率的比较采用χ2检验。结果由乙型肝炎导致肝硬化所引起的食管静脉曲张破裂出血所占比例最大;三腔二囊管临床运用可最大限度地挽救患者生命,为后期治疗提供时间;基础治疗包括止血、输血、抑酸、补液等,后期以硬化剂、套扎、硬化剂+套扎、手术、经颈静脉肝内门体分流术(TIPS)为主,但套扎运用最为广泛;患者出血初期各项指标变化有利于指导临床治疗,对患者预后具有良好的评估作用。结论扬州地区肝硬化引起的食管静脉曲张破裂出血病因呈现复杂交叉性,治疗方法仍需进一步完善,以达到个体化治疗水平;及时正确的救治,对提高临床疗效、降低病死率有重要意义;早期的健康体检,对疾病诊治起关键性的作用。 相似文献
3.
M. Parikh M.D. J. Duncombe M.B. B.S. G.A. Fielding M.D. 《Surgery for obesity and related diseases》2006,2(5):99-522
BACKGROUND: Many mild-to-moderately obese individuals (body mass index [BMI] 30-35 kg/m(2)) have serious diseases related to their obesity. Nonoperative therapy is ineffective in the long term, yet surgery has never been made widely available to this population. METHODS: Between 1996 and 2004, 93 patients with a BMI of 30-35 kg/m(2) underwent laparoscopic adjustable gastric banding with the LAP-BAND. All patients were referred by their primary physician, entered into a comprehensive bariatric surgery program at one Australian center, and operated on by one surgeon. Data on all patients were collected prospectively and entered into an electronic registry. The study parameters included preoperative age, gender, BMI, presence of co-morbidities, percentage of excess weight loss, and resolution of co-morbidities. RESULTS: The mean age was 44.6 years (range 16-76), mean weight was 98 kg, and the mean BMI was 32.7 kg/m(2) (range 30-34). Of the 93 patients, 42 (45%) had co-morbidities, including asthma, diabetes, hypertension, and sleep apnea. The proportion of patients in follow-up was 79%, 85%, and 89% at 1, 2, and 3 years, respectively. The mean weight was reduced to 71 kg at 1 year, 72 kg at 2 years, and 72 kg at 3 years. The mean BMI was reduced to 27.2 +/- 2.2, 27.3 +/- 3.1, and 27.6 +/- 3.7 kg/m(2), respectively, and the mean percentage of excess weight loss was 57.9% +/- 24.5%, 57.6 +/- 29.3%, and 53.8% +/- 32.8% at 1, 2, and 3 years, respectively. At 3 years, the BMI was 18-24 kg/m(2) in 34%, 25-29 kg/m(2) in 51%, and 30-35 kg/m(2) in 10%. At 3 years, the percentage of excess weight loss was <25% in 10%, 25-50% in 24%, 50-75% in 51%, and >75% in 10%. The co-morbidities improved or completely resolved in most patients. No mortality occurred. CONCLUSION: We are very encouraged by this series of low BMI patients treated with the LAP-BAND. Their weight loss has been good, the complications have been minimal, and the co-morbidities have partially or wholly resolved. With additional study, it is reasonable to expect the weight guidelines for bariatric surgery to be altered to include patients with a BMI of 30-35 kg/m(2). 相似文献
4.
YOSHINORI MORITA NOBUO AOYAMA DAISUKE SHIRASAKA MASATERU FUKUDA MASATO KASUGA 《Digestive endoscopy》2003,15(Z1):S12-S14
In Kobe University Hospital, a new method for endoscopic mucosal resection (EMR) using insulated‐tip electrosurgical knife (IT‐EMR) for early gastric cancer (EGC) was introduced from November 2001. To achieve an effective and safe IT‐EMR procedure, we use a high‐frequency surgical unit for cutting and coagulation (ERBOTOM ICC 200) with automatically controlled cutting mode (ENDOCUT). In this study, we show not only our results of IT‐EMR for EGC in comparison with those of the conventional strip biopsy method, but also the optimal conditions for the apparatus of a high‐frequency surgical unit to prevent complications such as bleeding and perforation. 相似文献
5.
o. goetze a. b. nikodem j. wiezcorek † m. banasch h. przuntek † t. mueller † w. e. schmidt & d. woitalla † 《Neurogastroenterology and motility》2006,18(5):369-375
Predictors of gastric emptying (GE) in patients with idiopathic Parkinson's disease (PD) of a solid and liquid meal are not well defined. For measurement of GE 80 patients with PD were randomly assigned to receive either a solid meal (250 kcal) containing 13C-octanoate (n = 40) or a liquid meal (315 kcal) with 13C-acetate (n = 40). All patient groups were off medication affecting motility and were matched for age, gender, body mass index, disease duration and severity, using Unified Parkinson's Disease Rating Scale (UPDRS). Gastric emptying was compared with a healthy control group (n = 40). Multiple regression analysis was used to determine predictors of gastric emptying. Exactly 88% and 38% of PD patients had delayed GE of solids and liquids respectively. Solid and liquid emptying was similar in women and men. There were no differences in GE in PD patients < 65 years of age when compared with patients > or = 65 years. Multiple regression analysis showed that motor handicaps such as rigour and action tremor are independent predictors of solid GE (r = 0.68, P < 0.001). The severity of motor impairment, but not any other neurological symptom, as assessed by UPDRS is associated with gastroparesis in PD and solid emptying is more likely to be delayed. 相似文献
6.
AKIKO TANAKA MASAHIRO MATSUMOTO YUJIRO HAYASHI KOJI TAKEUCHI 《Journal of gastroenterology and hepatology》2006,20(1):38-45
Background and Aim: We recently reported that cyclooxygenase (COX)-2 is upregulated in the rat small intestine after administration of indomethacin, and this may be the key to non-steroidal anti-inflammatory drug (NSAID)-induced intestinal damage. The present study investigated the mechanism for COX-2 expression induced in the rat small intestine by indomethacin, in relation with ulcerogenic processes.
Methods: Animals were given indomethacin or SC-560 p.o., and the intestinal mucosa was examined 24 h later.
Results: Indomethacin caused hemorrhagic lesions in the small intestine, accompanied with an increase in intestinal motility, bacterial invasion and inducible nitric oxide synthase (iNOS) activity, as well as the expression of COX-2 mRNA in the mucosa. Although SC-560 did not cause any damage, this agent caused intestinal hypermotility, the bacterial invasion and the upregulation of COX-2 expression. The mucosal PGE2 content was decreased by SC-560 at 3 h but recovered 12 h later, and this recovery of PGE2 was attenuated by both atropine and ampicillin, in addition to rofecoxib. The intestinal hypermotility response to indomethacin was prevented by both 16,16-dimethyl PGE2 and atropine, but not ampicillin. Yet all these agents inhibited not only the bacterial invasion but also the expression of COX-2 and iNOS activity in the intestinal mucosa following indomethacin treatment, resulting in the prevention of intestinal lesions.
Conclusion: These results suggest that COX-2 expression in the intestinal mucosa following the administration of indomethacin is associated with intestinal hypermotility and bacterial invasion. The intestinal hypermotility caused by COX-1 inhibition may be a key to COX-2 expression after administration of NSAIDs and their intestinal ulcerogenic properties. 相似文献
Methods: Animals were given indomethacin or SC-560 p.o., and the intestinal mucosa was examined 24 h later.
Results: Indomethacin caused hemorrhagic lesions in the small intestine, accompanied with an increase in intestinal motility, bacterial invasion and inducible nitric oxide synthase (iNOS) activity, as well as the expression of COX-2 mRNA in the mucosa. Although SC-560 did not cause any damage, this agent caused intestinal hypermotility, the bacterial invasion and the upregulation of COX-2 expression. The mucosal PGE
Conclusion: These results suggest that COX-2 expression in the intestinal mucosa following the administration of indomethacin is associated with intestinal hypermotility and bacterial invasion. The intestinal hypermotility caused by COX-1 inhibition may be a key to COX-2 expression after administration of NSAIDs and their intestinal ulcerogenic properties. 相似文献
7.
人端粒酶RNA的cDNA探针制备及其对胃粘膜细胞端粒酶RNA表达的检测 总被引:3,自引:0,他引:3
目的 建立人端粒酶RNA表达的检测方法。方法 制备人端粒酶RNA,(human telomeraseRNA,hTR)的cDNA探针,分别应用RNA斑点杂交与端粒重复序列扩增法(TRAP)分析检测不同胃粘膜的端粒酶RNA的表达与端粒酶活性。结果 人端粒酶RNA的cDNA探针制备成功。18例活检胃癌组织及45例手术胃癌组织RNA斑点杂交检测的阳性率均为l00%,相应TRAP分析的阳性率分别为88.89%、86.67%,低于RNA斑点杂交(P<0.05)。同时RNA斑点杂交结果提示在非癌胃组织中随着肠化程度增高人端粒酶RNA表达也增强。结论 RNA斑点杂交检测人端粒酶RNA,具有高度的敏感性和特异性,弥补了TRAP分析敏感性不足的缺点。 相似文献
8.
Background: The bariatric patient exists in dynamic relationship with family members and friends who have considerable influence
upon the patient and his or her surgical outcome. When family members and friends behave as intimate saboteurs, they attempt
to hamper, hurt, or subvert the bariatric patient's goal of achieving and maintaining a healthy body weight. Successful or
not, intimate saboteurs provide significant treatment challenges for the patient and the treatment team. Methods and Patients:
Patient profiles provide examples of intimate sabotage. The psychological construct of Family Systems Theory is used as a
plausible explanation for the sabotage of friends and family. Conclusions: Multidisciplinary professionals treating the bariatric
patient must be aware of the critical influence of intimate saboteurs and the tactics they use to sabotage. Treatment guidelines
recommended by Family Systems Theory are presented as strategies to mitigate the influence of intimate saboteurs. 相似文献
9.
10.
Lin Bo Wang Jian Guo Shen Li Feng Dong Chao Yang Xu Wen Jun Chen Shu Duo Xie Xiang Yang Song Ning Dai Xiao Ming Yuan 《Journal of gastrointestinal surgery》2008,12(8):1359-1363
We previously reported that lymphatic mapping using isosulfan blue can be used to identify sentinel nodes (SNs). This study
was undertaken to evaluate the feasibility of using the SN technique in treating early gastric cancer and to explore its usefulness
for minimal invasive surgery. Twenty-three patients with early gastric cancer who underwent SN biopsy were retrospectively
evaluated. Based on SN evaluation, individualized surgery was performed in five patients with T1N0M0 gastric cancer. When
pathological examination of frozen sections revealed metastasis in SNs, we performed a standard D2 gastrectomy. Laparoscopic
local resection was applied when the SN biopsy was negative. Our results showed that the success rate with SN biopsy in early
gastric cancer was 100%, as were the accuracy, sensitivity, and specificity. All five patients with early gastric cancer had
SNs negative for metastases both by frozen section and by postoperative pathology. Thus, all these patients underwent laparoscopic
local resection without extended lymphadenectomy. We conclude that SN biopsy is a useful tool to individualize the operative
procedure, and laparoscopic local resection can be safely performed using SN guidance in selected patients with early gastric
cancer. 相似文献