四磨汤为主治疗胸腰椎骨折后腹胀临床观察

目的:探讨四磨汤口服液联合双侧足三里穴新斯的明穴位注射治疗胸腰椎骨折后腹胀的临床疗效。方法:将140例胸腰椎骨折后出现腹胀的患者,按照随机对照的方法分组,分为治疗组和对照组各70例,治疗组采用口服四磨汤口服液联合双侧足三里穴新斯的明穴位注射治疗;对照组口服多潘立酮治疗,比较两组患者腹胀缓解及胃肠道功能恢复情况。结果:治疗组治疗胸腰椎骨折后腹胀总有效率为97.14%,对照组为82.86%,两组间差异有统计学意义。结论:四磨汤口服液联合双侧足三里穴新斯的明穴位注射治疗胸腰椎骨折后腹胀疗效显著,疗效优于多潘立酮。

开塞露纳肛加足三里穴注射甲氧氯普胺治疗腹部术后腹胀60例

目的:探讨腹部手术后腹胀的治疗方法。方法:对180例腹部术后腹胀患者,随机分为对照组(A组)60例,开塞露纳肛组例B组(60)例,综合治疗组(C)组60例。A组采取常规处理;B组采取常规处理及开塞露纳肛;C组采取常规处理、开塞露纳肛和双侧足三里穴注射甲氧氯普胺。结果:A、B、C3组治疗显效率分别为21.67%、61.67%和86.67%,3组相比差异显著(P<0.05);A、B、C3组治疗总有效率分别为48.33%、93.33%和100.00%,3组相比差异显著(P<0.05);B、C两组治疗显效率和总有效率均均高于A组,差异显著(P<0.0125);C组显效率高于B组,差异显著(P<0.0125);C有效率高于B组,但差异不显著(P>0.0125)。结论:开塞露纳肛加用足三里注射甲氧氯普胺治疗术后腹胀,其操作简单方便、实用性强、效果满意。

Inhibitory effects of carbon dioxide insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy

AIM:To evaluate the inhibitory effects of carbon dioxide (CO2) insufflation on pneumoperitoneum and bowel distension after percutaneous endoscopic gastrostomy (PEG).METHODS:A total of 73 consecutive patients who were undergoing PEG were enrolled in our study.After eliminating 13 patients who fitted our exclusion criteria,60 patients were randomly assigned to either CO2 (30 patients) or air insufflation (30 patients) groups.PEG was performed by pull-through technique after threepoint fixation of the gastric wall to the abdominal wall using a gastropexy device.Arterial blood gas analysis was performed immediately before and after the procedure.Abdominal X-ray was performed at 10 min and at 24 h after PEG to assess the extent of bowel distension.Abdominal computed tomography was performed at 24 h after the procedure to detect the presence of pneumoperitoneum.The outcomes of PEG for 7 d postprocedure were also investigated.RESULTS:Among 30 patients each for the air and the CO2 groups,PEG could not be conducted in 2 patients of the CO2 group,thus they were excluded.Analyses of the remaining 58 patients showed that the patients' backgrounds were not significantly different between the two groups.The elevation values of arterial partial pressure of CO2 in the air group and the CO2 group were 2.67 mmHg and 3.32 mmHg,respectively (P = 0.408).The evaluation of bowel distension on abdominal X ray revealed a significant decrease of small bowel distension in the CO2 group compared to the air group (P < 0.001) at 10 min and 24 h after PEG,whereas there was no significant difference in large bowel distension between the two groups.Pneumoperitoneum was observed only in the air group but not in the CO2 group (P = 0.003).There were no obvious differences in the laboratory data and clinical outcomes after PEG between the two groups.CONCLUSION:There was no adverse event associated with CO2 insufflation.CO2 insufflation is considered to be safer and more comfortable for PEG patients because of the lower incidence of pneumoperitoneum and less distension of the small bowel.

An unusual cause of dyspnoea complicating right upper abdominal swelling

A middle aged, non-addict male presented with right upper abdominal pain and swelling with respiratory distress. Examination revealed central cyanosis, bipedal pitting edema with prominent epigastric and back veins. Liver was enlarged, tender, spanned 20 cm without any splenomegaly or ascites. Other systems were clinically normal. Laboratory investigations showed polymorphonuclear leucocytosis with slightly deranged liver function. Abdominal ultrasonography showed an abscess in the right lobe of the liver with compressed inferior vena cava （IVC）, middle and left hepatic veins. Arterial blood gas （ABG） documented hypoxia with orthodeoxia and air-contrast echocardiography was suggestive of an intrapulmonary shunt. A diagnosis of hepato-pulmonary syndrome （HPS） was made with near normal liver function secondary to amebic liver abscess. It reversed completely following successful treatment of the liver abscess.

A case report of abdominal distention caused by herpes zoster

Gastrointestinal complications caused by herpes zoster are extremely rare. Here, we described a case of abdominal distention caused by herpes zoster. The patient was a 59-year-old female who suffered from unexplained paroxysmal and a burning pain on the right part of her waist and abdomen, accompanied by abdominal distention. Intestinal pseudo-obstruction was diagnosed by abdominal radiography. Distention of the right abdominal wall was still apparent after one month. In this report, we found that recovery from abdominal distention caused by herpes zoster is difficult and may require surgical intervention.

Duodeno-jejunal junction dyssynergia: Description of a novel syndrome

AIM： To investigate the hypothesis that duodeno-jejunal dyssynergia existed at the duodeno-jejunal junction.METHODS： Of 112 patients who complained of epigastric distension and discomfort after meals, we encountered nine patients in whom the duodeno-jejunal junction did not open on duodenal contraction. Seven healthy volunteers were included in the study. A condom which was inserted into the ist duodenum was filled up to 10 mL with saline in increments of 2 mL and pressure response to duodenal distension was recorded from the duodenum, duodeno-jejunal junction and the jejunum.RESULTS： In healthy volunteers, duodenal distension with 2 and 4 mL did not produce pressure changes, while 6 and up to 10 mL distension effected significant duodenal pressure increase, duodeno-jejunal junction pressure decrease but no jejunal pressure change. In patients, resting pressure and duodeno-jejunal junction and jejunal pressure response to 2 and 4 mL duodenal distension were similar to those of healthy volunteers. Six and up to 10 mL 1^st duodenal distension produced significant duodenal and duodeno-jejunal junction pressure increase and no jejunal pressure change.CONCLUSION： Duodeno-jejunal junction failed to open on duodenal contraction, a condition we call ＇duodenojejunal junction dyssynergia syndrome＇ which probably leads to stagnation of chyme in the duodenum and explains patients＇ manifestations.

Self-expanding metal stents for the palliation of malignant gastric outlet obstruction in patients with peritoneal carcinomatosis

AIM To evaluate the efficacy of self-expanding metal stents(SEMS) for the palliation of malignant gastric outlet obstruction in patients with and without peritoneal carcinomatosis(PC).METHODS We performed a retrospective analysis of 62 patients who underwent SEMS placement for treatment of malignant gastroduodenal obstruction at our hospital over a six-year period. Stents were deployed through the scope under combined fluoroscopic and endoscopic guidance. Technical success was defined as successful stent placement and expansion. Clinical success was defined as an improvement in the obstructive symptoms and discharge from hospital without additional parenteral nutrition. According to carcinomatosis status, patients were assigned into groups with or without evidence of peritoneal disease.RESULTS In most cases, obstruction was caused by pancreatic(47%) or gastric cancer(23%). Technical success was achieved in 96.8%(60/62), clinical success in 79%(49/62) of all patients. Signs of carcinomatosis were identified in 27 patients(43.5%). The diagnosis was confirmed by pathology or previous operation in 7 patients(11.2%) and suspected by CT, MRI or ultrasound in 20 patients(32.2%). Presence of carcinomatosis was associated with a significantly lower clinical success rate compared to patients with no evidence of peritoneal disease(66.7% vs 88.6%, P = 0.036). There was no significant difference in overall survival between patients with or without PC(median 48 d vs 70 d, P = 0.21), but patients showed significantly longer survival after clinical success of SEMS placement compared to those experiencing clinical failure(median 14.5 d vs 75 d, P = 0.0003).CONCLUSION Given the limited therapeutic options and a clinical success rate of at least 66.7%, we believe that SEMS are a reasonable treatment option in patients with malignant gastric outlet obstruction with peritoneal carcinomatosis.

The experience of professor YIN Ke-jing in the treatment of abdominal distension after abdominal surgery with warming-needle moxibustion at Gōngsūn(公孙 SP 4)

Objective To introduce the experience of professor YIN Ke-jing,a national senior and famous doctor of traditional Chinese medicine,in treatment of abdominal distension after abdominal surgery with warming-needle moxibustion at Gōngsūn（公孙 SP 4）.Methods Bilateral SP 4 were selected,and warming-needle moxibustion was adopted.The treatment was conducted for twice a day,and treatment for 3 days was considered as 1 course of treatment.The efficacy was evaluated after 2 courses.Results The total effective rate was 96.9% of the 32 patients after treatment and observation for 2 courses.Conclusion This therapeutic method was easy and simple with less acupoints selected and rapid onset of effect.With definite clinical efficacy,this method was worthy of being popularized.

Ocular myasthenia gravis accompanied by anosmia

We report a case of ocular myasthenia gravis(MG)accompanied by anosmia. A 76-year-old man had idiopathic anosmia of 2-year duration. Four months before consultation, he began to have drooping in the right upper eyelid along with muscle soreness,distension, and pain in the nape. His tongue was dark-red with a thin and white coating; his pulse was wiry and slippery. According to Traditional Chinese Medicine, eyelid drooping and anosmia are the main signs of liver constraint and spleen deficiency. In Western Medicine, the diagnosis was ocular MG and idiopathic anosmia. Our patient, along with the literature, suggests that anosmia may be an early symptom before MG. MG accompanied by anosmia could be a special subtype of MG according to antibody production and symptoms.

Effect Observation on Heat-sensitive Moxibustion for Abdominal Distension Following Laparoscopic Cholecystectomy

Objective: To observe the clinical effect of heat-sensitive moxibustion on abdominal distension following laparoscopic cholecystectomy. Methods: A total of 240 cases were randomly allocated into an observation group and a control group according to their admission sequence, 120 in each group. Cases in the observation group were treated with conventional care, glycerol enema and heat sensitive moxibustion, whereas cases in the control group were only treated with conventional care and glycerol enema. Then the passage of gas by anus within 24 h and improvement of abdominal distension were observed in both groups. Results: There were statistical differences in the emergence time of bowel sounds and the initial passage of gas by anus between the two groups(both P<0.05). The therapeutic effect in the observation group was better than that in the control group(P<0.05). Conclusion: Heat-sensitive moxibustion has reliable effect for abdominal distension following laparoscopic cholecystectomy.