胡珂教授从脾胃论治复发性口腔溃疡经验

目的:总结胡师治疗复发性口腔溃疡的经验。方法:通过收集胡师病案、相互探讨和疗效观察来总结复发性口腔溃疡的诊疗规律。结果:复发性口腔溃根源无不责于脾胃之气的盛衰,火、湿、热是其重要的致病条件。结论:胡珂教授治疗复发性口腔溃疡多从脾胃论治,以脾虚为本,火、湿、热邪是该病发病的关键因素,在调理脾胃的基础上辨证施治,随证治之。     

甲基莲心碱对长春新碱抗肿瘤作用的影响

【目的】观察甲基莲心碱(Neferine，Nef)在体外对长春新碱(Vincristine，VCR)抗人胃癌细胞(SGC7901)作用的影响以探讨其化疗增敏作用。【方法】MTT法检测药物的细胞毒性．PI染色流式细胞术检测细胞凋亡。【结果】2．5、5、10μmol／L Nef对SGC7901细胞无明显细胞毒性．但可使VCR对SGC7901的IC10从0．059μg／ml下降至0．036、0．030、0．014μg／ml。流式细胞术显示SGC7901细胞的自然凋亡率为3．1％，10μmol／L Nef与SGC7901细胞作用24h后，细胞凋亡率为3．2％，说明Nef并不显著诱导SGC7901细胞凋亡。0．5、2、4μg／ml VCR与SGC7901细胞作用24h后．细胞凋亡率分别为5．80％、6．59％、16．4％，VCR可一定程度的诱导SGC7901细胞凋亡；当与10μmol／L Nef合用时．其凋亡率明显增加．分别为18．5％、23．7％、35．4％。[结论]Nef能增强VCR的体外抗肿瘤作用．可能是一种化疗增敏剂。     

Acute upper gastrointestinal bleeding in operated stomach： Outcome of 105 cases

AIM: To compare the causes and clinical outcome of patients with acute upper gastrointestinal bleeding (AUGB) and a history of gastric surgery to those with AUGB but without a history of gastric surgery in the past.METHODS: The causes and clinical outcome were compared between 105 patients with AUGB and a history of gastric surgery, and 608 patients with AUGB but without a history of gastric surgery.RESULTS: Patients who underwent gastric surgery in the past were older (mean age: 68.1±11.7 years vs 62.8±17.8 years, P= 0.001), and the most common cause of bleeding was marginal ulcer in 63 patients (60%). No identifiable source of bleeding could be found in 22 patients (20.9%) compared to 42/608 (6.9%) in patients without a history of gastric surgery (P = 0.003). Endoscopic hemostasis was permanently successful in 26 out of 35 patients (74.3%) with peptic ulcers and active bleeding or non-bleeding visible vessel. Nine patients (8.6%) were operated due to continuing or recurrent bleeding,compared to 23/608 (3.8%) in the group of patients without gastric surgery in the past (P= 0.028). Especially in peptic ulcer bleeding patients, emergency surgery was more common in the group of patients with gastric surgery in the past [9/73 (12.3%) vs 19/360 (5.3%), P = 0.025].Moreover surgically treated patients in the past required more blood transfusion (3.3±4.0 vs 1.5±1.7, P = 0.0001) and longer hospitalization time (8.6±4.0 vs 6.9±4.9 d,P = 0.001) than patients without a history of gastric surgery. Mortality was not different between the two groups [4/105 (3.8%) vs 19/608 (3.1%)].CONCLUSION: Upper gastrointestinal bleeding seems to be more severe in surgically treated patients than in non-operated patients.     

The effect of probiotics on gastric mucosal permeability in humans administered with aspirin

Abstract

Objective. To examine whether a probiotic strain, Lactobacillus gasseri OLL2716 (LG21), can protect the gastric mucosal integrity from aspirin using urinary sucrose excretion (USE) test. Materials and methods. In the study using high-dose aspirin, the USE tests were carried out in 29 volunteers before and after LG21 treatment for 4 weeks. In the study using patients undergoing low-dose aspirin therapy, USE tests were performed in 37 subjects who took LG21 for 16 weeks. Stool occult blood was examined by the guaiac method. Results. In the former study, the elevation in the USE value after aspirin loading significantly decreased after LG21 treatment (Median ± SD; 0.244 ± 0.237 vs. 0.208 ± 0.112%, p = 0.018). In the latter study, the USE value significantly decreased in the period with LG21 treatment (p = 0.033), while no significant difference was found in the period without LG21 (p = 0.113). The number of positive occult blood tests decreased during LG21 treatment. Conclusions. The regular ingestion of LG21 may protect the integrity of the gastric mucosal permeability against aspirin.     

腹腔镜与开腹手术治疗大于5cm胃胃肠间质瘤的临床疗效对比

目的:探讨腹腔镜与开腹手术治疗大于5cm胃胃肠间质瘤(GIST)的临床疗效。方法:按随机数字表法将2016年1月~2018年2月接诊于某院的96例大于5cm胃GIST患者分为对照组和研究组各48例。对照组行开腹手术治疗,研究组行腹腔镜手术治疗,比较两组手术指标、术后复发风险和并发症发生情况。结果:两组手术用时差异不大;与对照组相比,研究组术中出血量较低,术后进食与排气时间、引流管拔除时间和住院时间较短(P<0.05);研究组术后复发风险略低于对照组(P>0.05),两组术后均未发生并发症。结论:腹腔镜手术治疗大于5cm胃GIST与开腹手术相比,具有创伤小、恢复快等优势,安全性较高。     

Gastric Biopsy in Peptic Ulcer: A Follow-up Study

Fundal biopsy was performed in 155 peptic ulcer patients (GU 65, DU 90) and antral in 43 (GU 17, DU 26) of the 155 patients. In GU fundal gastritis was found in 74 and antral in 94 % of the cases. In DU the percentages were 16 and 65 respectively. In a short-term follow-up of 30 patients (GU 15, DU 15) the state of the fundal macosa remained essentially unchanged in 19, became worse in 6, and possibly showed an improvement in 5. In a 1–6 year follow-up of 58 patients (GU 28, DU 30) the same type of mucosal structure was preserved in 40, worsening of the changes in 13, and some improvement in 5.     

王翠霞教授运用补中益气汤加减治疗缺乳经验

缺乳是指产后哺乳期内,产妇乳汁甚少或无乳可下者,称"缺乳"又称"产后乳汁不行,吾师认为导致缺乳的主要病因是由气血虚弱、肝郁气滞所致,根据产后多虚多瘀的特点产虚则宜补,塞则宜通,故导师运用补中益气汤加减治疗缺乳,临床上取得了显著的效果。     

Basal Chromogranin a and Gastrin Concentrations in Circulation Correlate to Endocrine Cell Proliferation in Type-A Gastritis

Background: It is not known whether plasma chromogranin analysis could he a complement to histology for detection and grading of gastric fundic mucosal endocrine cell proliferation in hypergastrinemic (type-A) atrophic gastritis. Methods: Gastric biopsy sections (body and antrum) from 43 patients with type-A gastritis (9 with gastric carcinoid) were examined for density and micronodules of argyrophil endocrine cells. Fasting blood samples were analyzed for chromogranin A and B. gastrin, and somatostatin. Results: All patients with carcinoid and 17 of the 34 without carcinoid had micronodules in the gastric fundic mucusa. The median plasma chromogranin A concentration was 5.7 (3.5–40.0) nmol/1 in patients with carcinoid, 4.5 (3.0–9.5) nmol/1 in patients with micronodules, and 3.7 (0.8–6.0) nmol/1 in patients without micronodules. Overall, chromogranin A concentrations correlated to endocrine cell densities in the fundic mucosa (r = 0.64, P < 0.001) and to gastrin concentrations (r = 0.71, P < 0.001). Plasma somatostatin and chromogranin B concentrations did not differ significantly between the groups. Conclusion: In type-A gastritis, analysis of plasma chromogranin A may be a useful complement to histology in estimating the endocrine cell mass. Moreover, subclinical type-A gastritis may be a source of error when chromogranin A analysis is used in the search for neuroendocrine neoplasia.     

Endocrine cells in the upper gastrointestinal tract in relation to gastrointestinal dysfunction in patients with familial amyloidotic polyneuropathy

Gastrointestinal (GI) dysfunction is a common complication of familial amyloidotic polyneuropathy (FAP). In previous reports, a decreased content of small and large intestinal endocrine cells has been found in patients with FAP and it has been suggested that this may contribute to the development of GI disturbances. The aim of the present study was to investigate the endocrine cell content in the stomach and duodenum of FAP patients, and to correlate the findings with gastric emptying.

Fifteen patients with FAP were included in the study. Twenty-eight subjects with macroscopically and histologically normal mucosa were used as controls for endocrine cell contents and 14 healthy subjects for gastric scintigraphy. The endocrine cells were identified by immunohis-tochemistry and quantified with image analysis. Gastric emptying time was detected by scintigraphy andendoscopy.

The number of chromogranin A-immunoreactive (IR) cells was reduced in all investigated parts of the GI tract except bulbus duodeni. Gastrin/CCK cell content was reduced in duodenum, but tended to be increased in antrum of the stomach (P=0.07). Otherwise, the content of all other endocrine cells types in the upper GI tract was reduced compared with controls. A correlation with malnutrition was found for gastric inhibitory polypeptide and secretin cell content in bulbus duodeni. Gastric scintigraphy disclosed delayed gastric emptying of solid food, but the finding was not correlated to the decreased content of neuroendocrine cells. The severity of endocrine cell depletion was not correlated to duration of GI disturbances.

The present study showed that the endocrine cells of the stomach are affected in FAP patients and that the abnormalities in the upper GI endocrine cells occur early during the course of the disease.