Parathion Poisoning—A New Antidote!

Two thousand five hundred forty-five cases of upper gastrointestinal tract hemorrhage were studied especially with a view to determining the indications for urgent surgical treatment.Decisions as to whether and when to operate were as follows:Immediate operation for patients over 50 years with a good history of ulcer and a severe initial bleed.Operation after the first repetition of bleeding in patients (1) over 50 with a good history and a mild initial bleed, (2) over 50 with inconclusive history but severe initial bleed, (3) under 50 with a good history and a severe initial bleed.In all other cases, operation was used only if conservative treatment failed.Absolute indications for operation were (a) association with perforation, (b) association with stenosis, (c) persistence of severe ulcer pain after hemorrhage, (d) continuous bleeding.Since operation is to be avoided if possible in cases of esophagitis, erosive gastritis and small acute or subacute ulcers, emergency gastroscopy has valuable uses.Where operation is deemed necessary and no obvious lesion found at laparotomy, blind gastrectomy^* appears to be the most satisfactory procedure.The mortality rate associated with upper gastrointestinal tract bleeding in patients less than 60 years of age was low (2.5 per cent). Even in cases in which operation was required, it was 6.2 per cent. Over 60 years the mortality rises steeply with increasing age, and in cases of operation the rise is even steeper.By using the methods of selection the overall mortality rate was appreciably reduced.     

Upper gastrointestinal endoscopy: its effects on patient management.

Out of 95 patients referred for upper gastrointestinal endoscopy after a barium-meal examination, 44 underwent a change in management. Some changes were minor but in 12 patients a decision on surgery was required. Seven of these patients were among a group of 13 for whom the referring consultant would have recommended laparotomy had endoscopy not been available, while the other five were subjected to an unplanned laparotomy. These findings support the practice of performing endoscopy on patients whose symptoms are not fully explained by barium-meal examination, especially patients aged over 45. In such cases the procedure also seems to be cost-effective.     

腹腔镜下直肠癌根治术在治疗老年患者中的临床研究

目的:探讨老年直肠癌患者行腹腔镜微创手术的治疗效果。方法:回顾性分析了2008年7月至2011年1月本院收治的91例老年直肠癌患者,按治疗方式分为腹腔镜组39例和开腹组52例,术后随访3年,比较分析两组患者围手术期、手术并发症及预后情况。结果:腹腔镜组患者的术中出血量、肠功能恢复时间、术后发热请况及住院时间均优于开腹组(P0.05);腹腔镜组并发症发生率为2.6%,低于开腹组的21.1%(P0.05);腹腔镜组局部复发率、远处转移率及死亡率与开腹组比较均无统计学差异(P0.05)。结论:老年直肠癌患者行腹腔镜手术与开腹手术效果相当,且安全、微创,但远期疗效尚需进一步研究证明。     

Upper gastrointestinal Kaposi's sarcoma in patients positive for HIV antibody without cutaneous disease

Six patients with antibodies to the human immunodeficiency virus (HIV) and with persistent gastrointestinal symptoms of HIV infection but without cutaneous lesions of Kaposi''s sarcoma underwent endoscopy. Four also underwent barium meal examination. In all six cases small lesions were seen in the stomach at endoscopy, and histological examination of biopsy specimens taken from the lesions confirmed the diagnosis of Kaposi''s sarcoma. The barium meal examinations were reported as normal in three patients and showed oesophageal candidiasis in the fourth.These findings suggest that Kaposi''s sarcoma of the upper gastrointestinal tract is common in patients positive for HIV antibody, even those without cutaneous lesions. Endoscopy, with biopsy of suspicious lesions, is necessary to make the diagnosis and is recommended in all HIV antibody positive patients with persistent upper gastrointestinal symptoms.     

Severe Gastrointestinal Haemorrhage: Haemangiomata Demonstrated by Selective Visceral Arteriography

Selective visceral arteriography was found to be invaluable in the management of two cases of severe gastrointestinal haemorrhage associated with cavernous haemangiomata (a large gastric haemangioma and a small jejunal haemangioma). It is suggested that arteriography may be indicated in cases where a previous laparotomy has not shown the cause of bleeding, when the patient''s general condition precludes a prolonged operation, and when superficial haemangiomata are found.     

常见消化道黏膜下肿物的临床特点及治疗方法

目的:探讨常见消化道黏膜下肿物(submucosal tumors,SMTs)的临床特点、治疗方式及安全性。方法:选择2014年5月至2016年3月在哈医大一院经内镜切除的并经病理及免疫组化明确诊断的消化道粘膜下肿物的患者共49例。所有患者术后3个月、6个月及12个月后随诊复查胃镜。统计每种肿物的患者临床症状,各种黏膜下肿物的性别分布、大小,及在消化道的分布。计算超声内镜的诊断率,总结病理结果。结果:49例患者中,间质瘤25例,类癌9例,平滑肌瘤8例,异位胰腺4例,脂肪瘤2例,颗粒细胞瘤1例。间质瘤分布以胃底、胃体多见。类癌以直肠最多见,胃内也可见。平滑肌瘤多分布于食管,也可见于胃。异位胰腺多分布于胃窦。通过内镜黏膜下挖除术(Endoscopic submucosal excavation,ESE)切除42例,粘膜下隧道切除术(Submucosal tunneling endoscopic resection,STER)切除4例,还有3例行内镜下黏膜切除(Endoscopic Mucosal Resection,EMR)。所有患者术后均无迟发性出血、严重感染及死亡病例发生。随访3-22个月,所有患者均无复发。结论:黏膜下肿物在内镜及超声内镜各有特点。超声内镜对黏膜下肿物的诊断与治疗具有重要的指导意义。双镜联合使SMTs的内镜下各种治疗方式(EMR、ESE、STER)更有安全保障,使患者受益最大。     

Intestinal obstruction

Despite improvements in knowledge of the pathologic physiology of intestinal obstruction, the introduction of gastrointestinal decompression, and more effective antibiotics, obstruction remains a serious disease with a high mortality rate. Although the diagnosis is often obscure, it can usually be made with a fair degree of accuracy by the history alone; pain is fairly constant and characteristically is of a cramping type simulated by very few other lesions. Distention is present in low lesions but absent in high lesions; on the contrary, vomiting is minimal in low lesions but prominent in high lesions. Visible peristaltic waves are almost pathognomonic of intestinal obstruction. Increased peristaltic sounds, as noted by auscultation, are extremely helpful in diagnosis; they are absent in paralytic ileus. Although intestinal obstruction is a surgical lesion, it must be remembered that in the type produced by adhesions the obstruction can be relieved by gastrointestinal decompression in 80 to 90 per cent of cases. Operation is usually indicated a short time after relief because of the probability of recurrence. In practically all other types of obstruction decompression is indicated only while the patient is being prepared for operation. Obviously any type of strangulation demands early operation. Strangulation can usually be diagnosed, particularly if it develops while the patient is under observation. Increase in pain, muscle spasm and pulse rate are important indications of development of strangulation. Dehydration and electrolytic imbalance are produced almost universally in high obstruction. Usually, it is unwise to wait until these two deficiencies are corrected before operation is undertaken, but correction must be well under way at the time of operation. Resections should be avoided in the presence of intestinal obstruction, but obviously will be necessary in strangulation. Operative technique must be expert and carried out with minimal trauma. Postoperative care is very important; important features are decompression, for two to three days, accurate fluid and electrolytic replacement, and transfusions.     

INTESTINAL OBSTRUCTION

Despite improvements in knowledge of the pathologic physiology of intestinal obstruction, the introduction of gastrointestinal decompression, and more effective antibiotics, obstruction remains a serious disease with a high mortality rate. Although the diagnosis is often obscure, it can usually be made with a fair degree of accuracy by the history alone; pain is fairly constant and characteristically is of a cramping type simulated by very few other lesions. Distention is present in low lesions but absent in high lesions; on the contrary, vomiting is minimal in low lesions but prominent in high lesions. Visible peristaltic waves are almost pathognomonic of intestinal obstruction. Increased peristaltic sounds, as noted by auscultation, are extremely helpful in diagnosis; they are absent in paralytic ileus.Although intestinal obstruction is a surgical lesion, it must be remembered that in the type produced by adhesions the obstruction can be relieved by gastrointestinal decompression in 80 to 90 per cent of cases. Operation is usually indicated a short time after relief because of the probability of recurrence. In practically all other types of obstruction decompression is indicated only while the patient is being prepared for operation. Obviously any type of strangulation demands early operation. Strangulation can usually be diagnosed, particularly if it develops while the patient is under observation. Increase in pain, muscle spasm and pulse rate are important indications of development of strangulation.Dehydration and electrolytic imbalance are produced almost universally in high obstruction. Usually, it is unwise to wait until these two deficiencies are corrected before operation is undertaken, but correction must be well under way at the time of operation. Resections should be avoided in the presence of intestinal obstruction, but obviously will be necessary in strangulation. Operative technique must be expert and carried out with minimal trauma. Postoperative care is very important; important features are decompression, for two to three days, accurate fluid and electrolytic replacement, and transfusions.     

Computed tomography of abdomen in staging and clinical management of lymphoma.

During July 1976 to Demember 1977, 150 patients with Hodgkin''s disease and 138 with non-Hodgkin''s lymphoma were examined by computed tomography (CT). In 45 cases 50 repeat examinations were conducted. Concurrent laparotomy and lymphography were performed on 68 and 56 patients respectively. The overall incidence of false-positive CT examinations as confirmed by laparotomy was 7.4%. In 18 patients with non-Hodgkin''s lymphoma in the abdomen there was good correlation between the two techniques. Of the 50 patients with Hodgkin''s disease who underwent laparotomy, 17 had splenic disease and 14 minimally enlarged lymph nodes in 20 areas; CT, however, detected only four diseased spleens and five minimally enlarged lymph nodes. Nevertheless, CT often detected enlarged lymph nodes missed by lymphography and was 23% more efficient than lymphography in detecting unsuspected disease. CT also detected unsuspected disease in patients with relapse of lymphoma. CT may replace other non-invasive investigations of abdominal disease in patients with lymphoma and give a reliable guide to prognosis. It does not, however, eliminate the need for laparotomy in staging Hodgkin''s disease.     

腔镜下Soave根治术与开腹改良Soave术治疗长段型先天性巨结肠患儿的疗效比较及对应激反应和控便功能的影响

摘要 目的：比较腔镜下Soave根治术与开腹改良Soave术治疗长段型先天性巨结肠（HD）患儿的疗效,观察两种术式对应激反应和控便功能的影响。方法：选取我院2017年4月～2020年9月期间收治的长段型HD患儿88例,根据手术方式的不同分为开腹组和微创组,例数分别为43例和45例。对比两组围术期指标、应激反应指标、控便功能和并发症发生情况。结果：微创组的术中失血量少于开腹组,手术时间、胃肠功能恢复时间、禁食时间、住院时间短于开腹组（P<0.05）,两组肠管切除长度组间对比无统计学差异（P>0.05）。两组患儿术后1 d心率（HR）、平均动脉压（MAP）较术前升高,血氧饱和度（SpO₂）较术前下降,但微创组HR、MAP低于开腹组,SpO₂高于开腹组（P<0.05）。两组患儿术后1年大便性状、排便次数、污粪、需要治疗（灌肠、药物、尿布）评分及Heikkinen总分均较术前升高,且微创组高于开腹组（P<0.05）。微创组的近期并发症总发生率和远期并发症总发生率均低于开腹组（P<0.05）。结论：与开腹改良Soave术相比,采用腔镜下Soave根治术治疗长段型HD患儿可缩短手术时间、禁食时间、住院时间、胃肠功能恢复时间,减少手术创伤,减轻机体应激反应,改善患儿控便功能,同时还可降低并发症发生率,效果较好。     

腹腔镜胆囊手术和开腹胆囊手术对术后肠黏连的影响比较

目的:比较腹腔镜胆囊手术和开腹胆囊手术对于术后肠黏连的影响,对比两种手术的有效性和安全性。方法:回顾选取在我院接受胆囊手术治疗的196例病患,根据术式分成开腹组和腹腔组,每组均为98例患者,对比分析组间手术指标以及术后出现肠黏连的情况,同时观察手术前后患者消化道生存质量变化。结果:腹腔镜组手术耗时(123.57±4.65 min)长于开腹组,术中出血(27.52±5.69 mL)、胃肠功能恢复用时(18.03±3.51 h)、术后住院时间(4.51±1.03)、肠黏连发生率(10.20%)少于开腹组,(P0.05);两组术前GLQI评分相仿(P0.05),术后GLQI评分显著高于组内术前(P0.05),且腹腔镜组术后GLQI评分显著高于开腹组(P0.05)。结论:与开腹手术相比,腹腔镜胆囊手术不仅手术创伤小、术后恢复时间短,而且术后肠粘连发生率低,值得推广。     

Decreased tuftsin concentrations in patients who have undergone splenectomy.

Serum tuftsin concentrations were measured, using a radioimmunoassay developed in Israel, in normal subjects and in patients who had undergone splenectomy. Concentrations in those who had undergone traumatic and elective splenectomy were much lower. The tuftsin concentration in 38 patients with Hodgkin''s disease who had undergone splenectomy during staging laparotomy was not significantly different from the mean concentration in other patients who had had elective splenectomy. In four patients who underwent splenectomy for non-malignant haematological disorders measurements made before and after operation showed that tuftsin concentrations fell significantly in the days after operation. The increased susceptibility to overwhelming infections of patients with Hodgkin''s disease and others who have undergone splenectomy may be related to the low tuftsin concentrations. As pre-splenectomy tuftsin concentrations in patients with Hodgkin''s disease were normal, the practice of performing staging laparotomy and splenectomy in patients with Hodgkin''s disease should perhaps be reconsidered.     

联合入路翻页式腹腔镜辅助右半结肠癌根治术与开腹根治术术后近期效果比较

摘要 目的：探讨联合入路翻页式腹腔镜辅助右半结肠癌根治术与开腹根治术术后近期效果比较。方法：选取2019年4月-2021年3月在南通大学附属肿瘤医院经CT和电子肠镜确诊的右伴结肠癌患者,所有患者均选择根治性右半结肠切除术（D2）。最后纳入研究对象77例,其中男性患者39例,女性患者38例,年龄37~75岁。根据手术方案将患者分为联合入路翻页式腹腔镜辅助手术40例,并命名为观察组,剩余37例行开放式根治术,为对照组。所有患者均提供了知情同意书。根据临床资料收集患者一般信息。记录围手术期结局为开腹手术或腹腔镜手术的手术时间,失血量,肛门排气时间,液体饮食时间,住院时间和30天之内的并发症和死亡率等。通过蛋白印迹分析患者术后7天血清内Polo样激酶（Polo-like Kinase 1,Plk1）、胸苷激酶1（Thymidine Kinase 1,TK1）、X连锁的凋亡蛋白抑制剂（X-linked inhibitor of apoptosis protein,XIAP）的活力。结果：两组患者一般资料比较无差异（P>0.05）。观察组较对照组的手术运行时间缩短,失血量减少,血管危险因素病发率降低（P<0.05）,淋巴结获得量两组比较无差异（P>0.05）。观察组较对照组的住院时间、第一次肛门排气时间、输液天数和胃肠功能恢复时间缩短（P<0.05）。观察组较对照组在吻合口漏、乳糜漏、术后腹腔出血和麻痹性肠梗阻等不良发生率比较无差异（P>0.05）,观察组较对照组的整体不良发生率升高（P<0.05）。观察组较对照组的Plk1、TK1、XIAP的蛋白表达降低（P<0.05）。结论：联合入路翻页式腹腔镜辅助右半结肠癌安全可行,且具有手术难度低,缩短手术时间,减少术中出血以及加快术后康复的优势。     

Gastrointestinal Disturbances Associated with Withdrawal of Ataractic Drugs

The psychological effects of abrupt withdrawal of ataractic drugs have been studied by others. Physical symptoms also occur under such circumstances and include abdominal pain, nausea and vomiting. Forty patients were divided into four groups of 10, each group receiving one of the following drugs: chlorpromazine, thioridazine, perphenazine or chlorprothixene. This medication was then suddenly withdrawn. In each of the chlorpromazine and thioridazine groups, three patients had gastrointestinal symptoms within 48 hours, lasting one to eight days. One patient on chlorprothixene, 450 mg. daily, experienced symptoms for six days. Perphenazine withdrawal produced no such symptoms. Thioridazine has little antiemetic action but perphenazine is prescribed for vomiting; hence it seems unlikely that the reported symptoms are due to a rebound action on the vomiting centre.These findings are relevant to the situation of withdrawal of ataractics prior to administration of anesthetics and to drug studies involving cross-over from an active compound to a placebo. The increasing use of ataractics suggests that this additional diagnostic possibility should be considered in the presence of obscure gastrointestinal symptoms.     

Elderly and younger patients selected to undergo coronary angiography.

OBJECTIVE--To establish and compare the characteristics of older (greater than or equal to 70 years) and younger patients with chest pain selected to undergo coronary angiography and by analysis of their subsequent management to assess the value of coronary angiography for older patients with chest pain. DESIGN--Retrospective analysis of clinical case notes and coronary angiography reports. SETTING--Cardiology department with referral population of one million in an Edinburgh hospital. PATIENTS--134 consecutive patients with chest pain aged 70 years or over investigated by coronary angiography between 1978 and 1988; 134 randomly selected patients aged under 70 investigated over the same period. MAIN OUTCOME MEASURES--Clinical and angiographic features at time of angiography and management after angiography. RESULTS--Older patients represented a small, but increasing, proportion of those investigated. Older patients had more severe symptoms at the time of angiography, were taking more antianginal drugs, and had had their symptoms for longer than younger patients. At angiography more older patients had triple vessel coronary disease, left main stem stenosis, or left ventricular impairment. After angiography similar proportions of older and younger patients underwent coronary artery surgery, with more elderly patients requiring urgent operation; although operative mortality was higher for elderly patients, symptomatic benefit was similar to that in younger patients. CONCLUSIONS--Older patients with angina selected to undergo coronary angiography and subsequent coronary surgery have more severe symptoms and underlying cardiac disease. Earlier referral and investigation might yield a population with lower operative risk. Selection of patients for coronary angiography and coronary artery surgery should be based on the potential for benefit and should avoid "agism."     

腹腔镜探查并治疗腹部恶性肿瘤术后肠梗阻的临床研究

目的:探讨腹腔镜辅助探查并治疗腹部恶性肿瘤术后肠梗阻患者的可行性及安全性。方法:应用腹腔镜技术对我院42例腹部恶性肿瘤术后患者行手术治疗,其中包括良性粘连性肠梗阻14例、肿瘤复发16例、原发性结肠癌1例、恶性肠粘连11例。结果:42例患者均在腹腔镜下明确诊断,其中18例患者在完全腹腔镜下手术治疗,13例患者在腹腔镜辅助下行手术治疗,6例患者腹腔严重粘连中转开腹手术治疗,5例患者腹腔广泛转移行保守治疗。腹腔镜手术时间为35~290min,平均住院日9.2±1.7d。患者术后疼痛较轻、下床活动时间及肠道功能恢复时间短、术后并发症少。结论:恶性肿瘤术后肠梗阻患者仍需手术治疗,在严格掌握手术适应症下,应用腹腔镜技术对恶性肿瘤术后肠梗阻病人的治疗是安全、可行的。     

A Clinical Study of Patients with Coronary Heart Disease Complicated with Hypertriglyceridemic Waist Phenotype

The objective of this study was to investigate the characteristics of coronary lesions in patients with coronary heart disease complicated with hypertriglyceridemic waist phenotype and determine the relation to risk factors. For this purpose, 105 patients with ≥50 % stenosis in one branch of coronary arteries as confirmed by coronary angiography were enrolled. Further, in this regard, 41 cases (i.e., case group) were complicated with hypertriglyceridemic waist phenotype, while 64 patients (i.e., control group) were not complicated with this phenotype. The data show that, as compared with control group, the patients in case group had higher coronary artery scores. The coronary lesions in case group were associated with waist triglycerides index and tumor necrosis factor (TNF)-α; partial regression coefficients were 0.774 (P < 0.001) and 0.250 (P = 0.001), respectively. Therefore, it was concluded that the patients with hypertriglyceridemic waist phenotype had a worse coronary heart disease condition, whereas waist triglycerides index and TNF-α related closely to the severity of coronary lesions.     

高频超声引导下导丝定位在不可触及乳腺包块切除术中的应用

目的:探讨高频超声引导下导丝定位在不可触及乳腺包块切除术中的应用价值。方法:回顾性分析90例临床不可触及但超声提示为乳腺包块的患者的临床资料,其中50例在高频超声引导乳腺病灶体表定位下行乳腺病灶切除术,40例在高频超声引导导丝定位下行乳腺病灶切除术。比较两组术前定位时间、手术时间、切除组织量/肿物组织量及术后并发症的发生情况、术后病理诊断及术后超声随访情况。结果:与体表定位组比较,导丝定位组定位时间显著延长(P0.05),手术时间明显缩短(P0.05),切除组织量/肿物组织量显著减小(P0.05)。体表定位组出现2例切口感染,5例血肿,两组不良反应的发生率相比差异无统计学意义(P0.05)。体表定位组良性48例(96.0%),恶性病灶2例(4.0%)。导丝定位组良性病灶36例(90.0%),恶性病灶4例(10.0%)。两组病理诊断为良/恶病灶的比例无统计学意义(P0.05)。术后超声随访6~12个月,病灶切除情况比较差异无统计学意义(P0.05)。结论:高频超声引导下导丝定位精确,可明显缩短手术时间,减少对正常乳腺组织的破坏,可作为行不可触及乳腺包块切除术的优先选择。     

Cervical intraepithelial neoplasia grade III (CIN III) and invasive cervical carcinoma: the yawning gap revisited and the treatment of risk

In a 3-year study of the population of Southampton and south-west Hampshire there were 10 times as many cases of CIN III compared with invasive squamous carcinoma (700 compared with 70). The peak incidence of CIN III per 1000 screened women years was in those aged 25-29 years, which was 20 years earlier than the peak incidence of invasive cervical cancer per 1000 women years at risk. Ninety percent of CIN III was diagnosed in women under 50 years. There were 14 cases of cervical glandular intraepithelial neoplasia grade III (CGIN III), three coexisting with CIN III, all in women aged under 50 years: the gap between intraepithelial and invasive lesions was not seen for glandular neoplasia. Although referral was for at least moderate dyskaryosis in 86.8% of women with CIN III or CGIN III, most had been screened previously, either having had mild abnormalities requiring repeat cytology (39.8%) or negative cytology (34.5%). Only 12 women aged > or = 50 years had previous negative cytology: 21.4% compared with 35.6% of women aged < 50 years (P = 0.034). The results of this study suggest that the best opportunity for preventing invasive squamous cell carcinoma lies in screening women aged 20-39 years when the incidence of CIN III in the screened population is highest and before the peak incidence of invasive disease. The results also indicate the importance of repeated screening and follow up of minor cytological abnormalities in the detection of CIN III. The benefit of screening must be regarded as a treatment of risk, since it is almost certain that a high proportion of CIN III regresses or persists unchanged.